Provider Demographics
NPI:1235508748
Name:REAM, ABIGAIL IDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:IDA
Last Name:REAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:IDA
Other - Last Name:ERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2519 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1672
Mailing Address - Country:US
Mailing Address - Phone:414-303-0722
Mailing Address - Fax:
Practice Address - Street 1:630 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3930
Practice Address - Country:US
Practice Address - Phone:855-607-8242
Practice Address - Fax:715-848-0425
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3543103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist