Provider Demographics
NPI:1194561753
Name:LANDRY, ABIGAIL ELIZABETH (AUD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:LANDRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W PARKER RD STE G24
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8105
Mailing Address - Country:US
Mailing Address - Phone:972-378-0633
Mailing Address - Fax:
Practice Address - Street 1:6300 W PARKER RD STE G24
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8105
Practice Address - Country:US
Practice Address - Phone:972-378-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81665231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist