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General NPI Number Information
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NPI Number | 1649680141
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Entity Type | Organization
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Legal Business Name | FUNDAMENTAL SPEECH THERAPY SERVICES INC.
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 2562 FAIRBURN RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1461
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Country | US
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Telephone | 770-317-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 BRIDGE MILL AVE
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City | CANTON
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State | GA
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Zip | 30114-7797
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Country | US
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Telephone | 770-317-5993
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LABRITA JEANENE CASH-BASKETT
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Credential | CCC-SLP
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Telephone | 770-317-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA3000X
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Taxonomy Name | Augmentative Communication Clinic/Center
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License Number | 0005319
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 0005319
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License Number State | GA
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