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Individual
SUSAN STREET
Active
Individual
SUSAN STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.001124
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1353048K
—
IL
Enumeration date
12/11/2017
Last updated
12/11/2017
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