Provider Demographics
NPI:1629714837
Name:PRUDDEN, ABIGAIL (AUD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:PRUDDEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 W 110TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1501
Mailing Address - Country:US
Mailing Address - Phone:913-521-9090
Mailing Address - Fax:913-521-9955
Practice Address - Street 1:458 NE 291 HWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-2501
Practice Address - Country:US
Practice Address - Phone:816-507-8885
Practice Address - Fax:816-533-4344
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1885237700000X
MO2022024985231H00000X
KS2441231H00000X
MO231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist