Provider Demographics
NPI:1346646288
Name:HERTEL, ABBY LOUISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LOUISE
Last Name:HERTEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5314
Mailing Address - Country:US
Mailing Address - Phone:407-495-7649
Mailing Address - Fax:
Practice Address - Street 1:2917 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-495-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist