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General NPI Number Information
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NPI Number | 1801091590
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Entity Type | Individual
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Provider Name | ROBERT JAY KISSEL M.A.CCCSLP
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16 TECHNOLOGY DR STE 116
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City | IRVINE
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State | CA
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Zip | 92618-2326
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Country | US
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Telephone | 949-462-9802
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Fax | 949-462-9824
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Provider Business Mailing Address
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Address Line | 1101 W STEVENS AVE APT 147
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City | SANTA ANA
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State | CA
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Zip | 92707-5063
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Country | US
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Telephone | 714-549-5045
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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 | 3619
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License Number State | CA
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