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General NPI Number Information
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NPI Number | 1770096638
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Entity Type | Individual
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Provider Name | MEGHAN DEBRA MOHR MA, CCC-SLP, TSSLD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 650 UDALL RD
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City | WEST ISLIP
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State | NY
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Zip | 11795-2117
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Country | US
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Telephone | 631-422-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 166 8TH AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2310
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Country | US
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Telephone | 631-291-2573
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 027247
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License Number State | NY
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