Provider Demographics
NPI:1063846152
Name:CARLSON, ABIGAIL LOU (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LOU
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSOURI ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3148
Mailing Address - Country:US
Mailing Address - Phone:870-400-0179
Mailing Address - Fax:870-400-0479
Practice Address - Street 1:610 N MISSOURI ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3148
Practice Address - Country:US
Practice Address - Phone:870-400-0179
Practice Address - Fax:870-400-0479
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist