Provider Demographics
NPI:1821712928
Name:ABBOTT, SERENA RUTH
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:RUTH
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 FORSYTH CT
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4364
Mailing Address - Country:US
Mailing Address - Phone:336-152-3148
Mailing Address - Fax:
Practice Address - Street 1:302 FORSYTH CT
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4364
Practice Address - Country:US
Practice Address - Phone:336-152-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant