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General NPI Number Information
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NPI Number | 1649809690
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Entity Type | Individual
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Provider Name | KYLEN ELIZABETH SMITH M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 30 N MAIN AVE
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City | ALBANY
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State | NY
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Zip | 12203-1410
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Country | US
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Telephone | 518-453-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 240 SHAKER RUN
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City | ALBANY
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State | NY
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Zip | 12205-2453
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Country | US
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Telephone | 518-764-2059
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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 | 14342287
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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 | 030076
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License Number State | NY
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