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General NPI Number Information
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NPI Number | 1689152324
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Entity Type | Individual
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Provider Name | KAYLEE ELIZABETH DE FALKENBERG B.S.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 6848 MAGNOLIA AVE STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92506-2898
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Country | US
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Telephone | 951-779-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 MUSTANG DR
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City | ONTARIO
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State | CA
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Zip | 91761-9198
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Country | US
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Telephone | 909-643-6709
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 4972
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License Number State | CA
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