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General NPI Number Information
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NPI Number | 1962292169
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Entity Type | Individual
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Provider Name | MAXWELL PAUL ATZEMIS CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 2338 LEMAY FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3127
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Country | US
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Telephone | 314-339-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 9503 BREUER DR
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City | AFFTON
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State | MO
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Zip | 63123-6507
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Country | US
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Telephone | 314-435-1368
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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 | 14453223
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License Number State |
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