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General NPI Number Information
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NPI Number | 1649037979
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Entity Type | Organization
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Legal Business Name | CLINICAL SUPERVISION SOLUTIONS
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 1401 21ST ST # 10048
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 757-272-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 21ST ST # 10048
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST/ OWNER
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Name | CASSIDY KOBIALKA
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Credential | M.S., CCC-SLP
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Telephone | 757-272-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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