Provider Demographics
NPI:1588905855
Name:MENDOZA, ABIGAIL (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 FREMONT AVE N
Mailing Address - Street 2:APT 404
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7293
Mailing Address - Country:US
Mailing Address - Phone:915-269-2828
Mailing Address - Fax:
Practice Address - Street 1:4459 FREMONT AVE N
Practice Address - Street 2:APT 404
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7293
Practice Address - Country:US
Practice Address - Phone:915-269-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAABIMENDOMedicaid