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General NPI Number Information
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NPI Number | 1740857796
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Entity Type | Organization
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Legal Business Name | ACTIVE SPEECH THERAPY PLLC
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 5840 N CANTON CENTER RD STE 224
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City | CANTON
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State | MI
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Zip | 48187-2684
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Country | US
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Telephone | 248-896-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 480 N CANTON CENTER RD UNIT 871812
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City | CANTON
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State | MI
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Zip | 48187-8773
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Country | US
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Telephone | 248-896-1209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GURPREET CHAWLA
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Credential |
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Telephone | 248-896-1209
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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 |
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License Number State |
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