Provider Demographics
NPI:1609551514
Name:REA, ABBY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:REA
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 1:1509 S STATE RD STE E
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1966
Mailing Address - Country:US
Mailing Address - Phone:810-412-4183
Mailing Address - Fax:810-309-8635
Practice Address - Street 1:1509 S STATE RD STE E
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1966
Practice Address - Country:US
Practice Address - Phone:810-412-4183
Practice Address - Fax:810-309-8635
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI710100765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist