Provider Demographics
NPI:1750856415
Name:ABIGAIL DESJARDIEN, M.A. CCC-SLP, LLC
Entity Type:Organization
Organization Name:ABIGAIL DESJARDIEN, M.A. CCC-SLP, LLC
Other - Org Name:NORTHSHORE PEDIATRIC SPEECH AND LANGUAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESJARDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:425-419-6199
Mailing Address - Street 1:19207 63RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3329
Mailing Address - Country:US
Mailing Address - Phone:360-920-3938
Mailing Address - Fax:
Practice Address - Street 1:18208 66TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-419-6199
Practice Address - Fax:855-891-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60051932235Z00000X
261QH0700X, 261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy