Provider Demographics
NPI:1063003507
Name:ABC THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:ABC THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANEY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:318-884-8936
Mailing Address - Street 1:15095 LAUREL OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4219
Mailing Address - Country:US
Mailing Address - Phone:318-884-8936
Mailing Address - Fax:
Practice Address - Street 1:15095 LAUREL OAK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4219
Practice Address - Country:US
Practice Address - Phone:318-884-8936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty