Provider Demographics
NPI:1225815533
Name:LASNETSKI, ABIGAIL NOEL (MA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NOEL
Last Name:LASNETSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 HOG MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-6450
Mailing Address - Country:US
Mailing Address - Phone:678-828-8584
Mailing Address - Fax:
Practice Address - Street 1:4875 HOG MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-6450
Practice Address - Country:US
Practice Address - Phone:678-828-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist