Provider Demographics
NPI:1134459522
Name:BOLL, ABBIE ALICE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABBIE
Middle Name:ALICE
Last Name:BOLL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 W PERSIMMON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7054
Mailing Address - Country:US
Mailing Address - Phone:870-577-5854
Mailing Address - Fax:
Practice Address - Street 1:272 SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-3124
Practice Address - Country:US
Practice Address - Phone:479-839-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184101721Medicaid