Provider Demographics
NPI:1134495385
Name:ABRAHAM, ANN LESLIE (MA/CCC/SLP-L)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LESLIE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MA/CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 TUDOR LN
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3426
Mailing Address - Country:US
Mailing Address - Phone:815-218-9047
Mailing Address - Fax:
Practice Address - Street 1:6345 TUDOR LN
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3426
Practice Address - Country:US
Practice Address - Phone:815-218-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist