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General NPI Number Information
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NPI Number | 1871902270
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Entity Type | Individual
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Provider Name | MARY LOU REARDON M.A., SLP/ CCC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 6740 LOVELAND MIAMIVILLE RD
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City | LOVELAND
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State | OH
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Zip | 45140-8795
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Country | US
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Telephone | 513-697-3045
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Fax | 513-683-1584
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Provider Business Mailing Address
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Address Line | 6740 LOVELAND MIAMIVILLE RD
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City | LOVELAND
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State | OH
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Zip | 45140-8795
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Country | US
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Telephone | 513-697-3045
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Fax | 513-683-1584
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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 | SP 4257
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License Number State | OH
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