Provider Demographics
NPI:1215533278
Name:FISHER, ABIGAIL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:418 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1626
Mailing Address - Country:US
Mailing Address - Phone:417-451-8600
Mailing Address - Fax:
Practice Address - Street 1:418 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1626
Practice Address - Country:US
Practice Address - Phone:417-451-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012034291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012034291Medicaid