Provider Demographics
NPI:1851921613
Name:BRANNEN, ABIGAIL (SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BRANNEN
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 1:280 SKYLINE PKWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3841
Mailing Address - Country:US
Mailing Address - Phone:850-694-3082
Mailing Address - Fax:
Practice Address - Street 1:1351 JENNINGS MILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7237
Practice Address - Country:US
Practice Address - Phone:850-694-3082
Practice Address - Fax:706-510-1372
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15388235Z00000X
GASLP011931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist