Provider Demographics
NPI:1962158600
Name:FAIR, ABIGAIL (SLP-A)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 S WESTGATE WAY APT 5103
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1665
Mailing Address - Country:US
Mailing Address - Phone:469-849-5649
Mailing Address - Fax:
Practice Address - Street 1:3601 MAPLESHADE LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5753
Practice Address - Country:US
Practice Address - Phone:469-849-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty