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General NPI Number Information
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NPI Number | 1699183434
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Entity Type | Organization
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Legal Business Name | THERAPYZONE, LLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 2179 LAWRENCEVILLE HWY STE 207
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7712
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Country | US
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Telephone | 770-871-1922
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 HEDINGTON CIR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3718
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Country | US
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Telephone | 770-871-1922
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | JON SINGLETON WILSON
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Credential | M.S., CCC-SLP
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Telephone | 770-871-1922
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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 | SLP007911
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License Number State | GA
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