Provider Demographics
NPI:1316431422
Name:FOUTCH, ABBY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:FOUTCH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1227
Practice Address - Country:US
Practice Address - Phone:402-990-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist