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NPI 1780961714

NPI 1780961714 : MRS. LISA BETH LEWIS KLEIN : ROCKVILLE CENTRE, NY

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General NPI Number Information
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    NPI Number           |    1780961714
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    Entity Type          |    Individual 
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    Provider Name        |    MRS. LISA BETH LEWIS KLEIN
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    11/04/2011
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    Last Update Date     |    11/04/2011
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Provider Practice Location Address
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    Address Line         |    11 MEADOW LN 
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    City                 |    ROCKVILLE CENTRE
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    State                |    NY
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    Zip                  |    11570-3226
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    Country              |    US
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    Telephone            |    516-223-1473
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    11 MEADOW LN 
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    City                 |    ROCKVILLE CENTRE
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    State                |    NY
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    Zip                  |    11570-3226
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    Country              |    US
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    Telephone            |    
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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       |    58003437
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    License Number State |    NY
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