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1710564257 NPI number — LAB SPEECH LANGUAGE

NPI Number: 1710564257
Health Care Provider/Practitioner: LAB SPEECH LANGUAGE

Information about “1710564257” NPI (LAB SPEECH LANGUAGE) exists in 1710564257 in HTML format HTML  |  1710564257 in plain Text format TXT  |  1710564257 in PDF (Portable Document Format) PDF  |  1710564257 in an XML format XML  formats.

NPI Number : 1710564257 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710564257",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LAB SPEECH LANGUAGE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "261 VALENTINE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POMFRET CENTER",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06259-2116",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-331-5421",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "261 VALENTINE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POMFRET CENTER",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06259-2116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-331-5421",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/29/2021",
    "LastUpdateDate": "03/29/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BLANCHETTE",
    "AuthorizedOfficialFirstName": "LISA",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "SPEECH LANGUAGE PATHOLOGIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.A. SLP-CCC",
    "AuthorizedOfficialTelephoneNumber": "203-331-5412",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0700X",
        "TaxonomyName": "Hearing and Speech Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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