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General NPI Number Information
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NPI Number | 1861840233
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Entity Type | Organization
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Legal Business Name | ASSURED CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 1845 N FARWELL AVE SUITE 203
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City | MILWAUKEE
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State | WI
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Zip | 53202-1793
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Country | US
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Telephone | 414-810-2715
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14781
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City | MILWAUKEE
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State | WI
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Zip | 53214-0781
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Country | US
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Telephone | 414-810-2715
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. CANDACE E COATES
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Credential | MSW
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Telephone | 414-810-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8053
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License Number State | WI
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