Provider Demographics
NPI:1093063471
Name:BANNISTER, ABBY ROCHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:ROCHELLE
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 IRELANDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-9749
Mailing Address - Country:US
Mailing Address - Phone:573-259-4747
Mailing Address - Fax:
Practice Address - Street 1:205 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2809
Practice Address - Country:US
Practice Address - Phone:607-654-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02206-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist