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General NPI Number Information
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NPI Number | 1689052912
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Entity Type | Individual
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Provider Name | KATHRYN L SOUTHERN M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 2314 YORKSHIRE RD STE 200
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City | ANN ARBOR
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State | MI
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Zip | 48104-5041
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Country | US
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Telephone | 734-973-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 11399 MASTERS RD
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City | RILEY
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State | MI
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Zip | 48041-2604
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Country | US
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Telephone | 586-817-3997
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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 | 7101001028
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License Number State | MI
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