{
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"FirstLineMailingAddress": "2108 W ADAMS AVE",
"SecondLineMailingAddress": null,
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"MailingAddressPostalCode": "76504-3918",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "254-771-5462",
"MailingAddressFaxNumber": "254-771-5463",
"FirstLinePracticeLocationAddress": "345 OWEN LN",
"SecondLinePracticeLocationAddress": "STE 130",
"PracticeLocationAddressCityName": "WACO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76710-5587",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "254-709-8847",
"PracticeLocationAddressFaxNumber": "254-857-8867",
"EnumerationDate": "05/06/2010",
"LastUpdateDate": "05/06/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAULKINBERRY",
"AuthorizedOfficialFirstName": "REBEKAH",
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"AuthorizedOfficialCredential": "MS, CCC/SLP",
"AuthorizedOfficialTelephoneNumber": "254-709-8847",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
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"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
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}
}
}
}