Provider Demographics
NPI:1083230684
Name:MACMILLAN, ABBEY KENNEDY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:KENNEDY
Last Name:MACMILLAN
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 1:14015 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5176
Mailing Address - Country:US
Mailing Address - Phone:502-930-5425
Mailing Address - Fax:
Practice Address - Street 1:14015 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5176
Practice Address - Country:US
Practice Address - Phone:502-930-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264183235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY264183OtherSTATE LICENSE NUMBER