Provider Demographics
NPI:1386422343
Name:BAGBY, ABBY LYNN
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:LYNN
Last Name:BAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LYNN
Other - Last Name:BEUTJER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6703 FRANKS RD
Mailing Address - Street 2:
Mailing Address - City:BYRNES MILL
Mailing Address - State:MO
Mailing Address - Zip Code:63051-1004
Mailing Address - Country:US
Mailing Address - Phone:678-689-7001
Mailing Address - Fax:
Practice Address - Street 1:101 INDIAN WARPATH DR
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-3463
Practice Address - Country:US
Practice Address - Phone:636-271-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist