Provider Demographics
NPI:1164099305
Name:PETTY, ABIGAIL SEAGLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:SEAGLE
Last Name:PETTY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:LORA
Other - Last Name:SEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 S 41ST ST APT 137
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3371
Mailing Address - Country:US
Mailing Address - Phone:828-508-2962
Mailing Address - Fax:
Practice Address - Street 1:202 10TH ST SE STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2434
Practice Address - Country:US
Practice Address - Phone:319-399-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108769231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist