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General NPI Number Information
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NPI Number | 1588817639
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Entity Type | Individual
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Provider Name | MINDY HARTMAN LAVINE M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 11/02/2008
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Provider Practice Location Address
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Address Line | 551 BAY RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-1441
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Country | US
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Telephone | 518-798-4056
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Fax |
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Provider Business Mailing Address
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Address Line | 116 GRANT AVE
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City | GLENS FALLS
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State | NY
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Zip | 12801-2634
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Country | US
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Telephone | 518-232-6395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 013594-1
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License Number State | NY
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