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General NPI Number Information
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NPI Number | 1770853871
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Entity Type | Individual
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Provider Name | KIM H LEONARD M.A./CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 51 SCHOOL ST
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-2231
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Country | US
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Telephone | 631-471-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 190 HIGHLAND AVE
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City | NORTHPORT
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State | NY
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Zip | 11768-1646
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Country | US
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Telephone | 631-757-1158
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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 | 58007045
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License Number State | NY
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