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General NPI Number Information
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NPI Number | 1689103319
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Entity Type | Organization
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Legal Business Name | MOON LILY THERAPY PPLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2110 SHEARN ST UNIT F41
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City | HOUSTON
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State | TX
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Zip | 77007-3972
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Country | US
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Telephone | 713-562-2572
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Fax | 713-932-6713
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Provider Business Mailing Address
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Address Line | 2110 SHEARN ST UNIT F412110
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City | HOUSTON
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State | TX
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Zip | 77007-3962
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Country | US
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Telephone | 713-562-2572
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Fax | 713-932-6713
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | MR. ANGELA SUE OWENS
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Credential | SLP
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Telephone | 713-562-2572
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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 | 105616
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License Number State | TX
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