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General NPI Number Information
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NPI Number | 1649723727
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Entity Type | Organization
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Legal Business Name | SPEECH LANGUAGE THERAPY OF CENTRAL NEW YORK LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 4266 ACME RD
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City | FRANKFORT
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State | NY
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Zip | 13340-3504
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Country | US
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Telephone | 315-732-9368
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Fax |
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Provider Business Mailing Address
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Address Line | 12 CENTRAL PLZ
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City | ILION
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State | NY
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Zip | 13357-1701
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Country | US
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Telephone | 315-525-5275
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Fax | 315-293-2149
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | RENEE ENGLISH
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Credential |
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Telephone | 315-525-5275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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