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General NPI Number Information
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NPI Number | 1639580517
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Entity Type | Organization
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Legal Business Name | RESTORATIVE SPEECH AND SWALLOW LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 220 W EVERGREEN AVE UNIT B-1
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3862
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Country | US
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Telephone | 215-360-8012
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Fax | 866-456-4839
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Provider Business Mailing Address
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Address Line | 220 W EVERGREEN AVE UNIT B-1
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3862
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Country | US
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Telephone | 215-360-8012
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Fax | 866-456-4839
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY P LUSTIG
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Credential | PHD, MPH, CCC-SLP
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Telephone | 215-360-8012
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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 | SL-005981-L
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License Number State | PA
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