Provider Demographics
NPI:1063506327
Name:MUMFORD, ABBE NICOLE (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABBE
Middle Name:NICOLE
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:ABBE
Other - Middle Name:NICOLE
Other - Last Name:RISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 DIETZ LN
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7364
Mailing Address - Country:US
Mailing Address - Phone:740-454-9367
Mailing Address - Fax:
Practice Address - Street 1:205 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3791
Practice Address - Country:US
Practice Address - Phone:740-452-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8198235Z00000X
OHSP.08198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist