Provider Demographics
NPI:1164844825
Name:BREWER, ABBY (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:
Last Name:BREWER
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 1:4121 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6336
Mailing Address - Country:US
Mailing Address - Phone:580-353-8900
Mailing Address - Fax:580-353-8903
Practice Address - Street 1:4121 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6336
Practice Address - Country:US
Practice Address - Phone:580-353-8900
Practice Address - Fax:580-353-8903
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist