Provider Demographics
NPI:1851651152
Name:COGHLAN, ABIGAIL BRIGHID (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:BRIGHID
Last Name:COGHLAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 N MILWAUKEE AVE
Mailing Address - Street 2:UNIT 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7886
Mailing Address - Country:US
Mailing Address - Phone:708-334-8411
Mailing Address - Fax:
Practice Address - Street 1:2923 N MILWAUKEE AVE
Practice Address - Street 2:UNIT 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7886
Practice Address - Country:US
Practice Address - Phone:708-334-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist