Provider Demographics
NPI:1801043450
Name:CHADWICK, ABBIE (SLP)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 NESBIT RD
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-9134
Mailing Address - Country:US
Mailing Address - Phone:901-833-0920
Mailing Address - Fax:
Practice Address - Street 1:2860 NESBIT RD
Practice Address - Street 2:
Practice Address - City:NESBIT
Practice Address - State:MS
Practice Address - Zip Code:38651-9134
Practice Address - Country:US
Practice Address - Phone:901-833-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001207235Z00000X
MSS2875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist