Provider Demographics
NPI:1306354857
Name:MOOG, ABBIGAIL LYNN (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:ABBIGAIL
Middle Name:LYNN
Last Name:MOOG
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S STONECREST RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7567
Mailing Address - Country:US
Mailing Address - Phone:913-428-6008
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST MS 3007
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-0677
Practice Address - Fax:913-588-0677
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical