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General NPI Number Information
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NPI Number | 1740672351
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Entity Type | Organization
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Legal Business Name | EAST LOUISVILLE SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 9114 COX CT APT 4
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City | LOUISVILLE
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State | KY
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Zip | 40241-3239
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Country | US
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Telephone | 502-291-3134
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Fax | 502-324-4079
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Provider Business Mailing Address
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Address Line | 9114 COX CT APT 4
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City | LOUISVILLE
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State | KY
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Zip | 40241-3239
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Country | US
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Telephone | 502-291-3134
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Fax | 502-324-4079
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. AMBER L DEVINE-STINSON
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Credential | MS, CCC-SLP
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Telephone | 502-291-3134
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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 | 4268
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License Number State | KY
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