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General NPI Number Information
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NPI Number | 1619319670
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Entity Type | Individual
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Provider Name | ROSE LEE MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 500 SUSSEX DR
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City | PORTSMOUTH
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State | VA
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Zip | 23707-1131
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Country | US
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Telephone | 513-260-3484
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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 | LL61052600
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP000654
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License Number State | DC
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