Provider Demographics
NPI:1104598556
Name:PAULSON, ABIGAIL LEE
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:LEE
Last Name:PAULSON
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 1:761 S STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9577
Mailing Address - Country:US
Mailing Address - Phone:541-297-9660
Mailing Address - Fax:
Practice Address - Street 1:761 S STONY POINT RD
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9577
Practice Address - Country:US
Practice Address - Phone:541-297-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician