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General NPI Number Information
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NPI Number | 1790454817
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Entity Type | Organization
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Legal Business Name | NWI OROFACIAL MYOFUNCTIONAL THERAPY, LLC
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 566 N INDIANA AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-3412
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Country | US
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Telephone | 219-661-7271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2425
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City | VALPARAISO
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State | IN
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Zip | 46384-2425
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Country | US
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Telephone | 219-661-7271
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Fax |
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Authorized Official
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Title or Position | MYOFUNCTIONAL THERAPIST
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Name | MRS. STACY LASHENIK
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Credential | LDH
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Telephone | 219-661-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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