Provider Demographics
NPI:1285393611
Name:HARTJES, ABIGAIL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:HARTJES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 53RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-9013
Mailing Address - Country:US
Mailing Address - Phone:608-347-1419
Mailing Address - Fax:
Practice Address - Street 1:5214 53RD AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-9013
Practice Address - Country:US
Practice Address - Phone:608-347-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61240009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist