Provider Demographics
NPI:1063872737
Name:CLONINGER, ABBY KAY
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:KAY
Last Name:CLONINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22461 I 30
Mailing Address - Street 2:BUILDING 1100A
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22461 I 30
Practice Address - Street 2:BUILDING 1100A
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2364
Practice Address - Country:US
Practice Address - Phone:501-794-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 2355S0801X
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant