Provider Demographics
NPI:1912379330
Name:BURKLOW, ABIGAIL TRESE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:TRESE
Last Name:BURKLOW
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 1:1310 23RD ST APT 703
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-5328
Mailing Address - Country:US
Mailing Address - Phone:806-654-5688
Mailing Address - Fax:
Practice Address - Street 1:600 S TYLER ST
Practice Address - Street 2:SUITE 805
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2353
Practice Address - Country:US
Practice Address - Phone:806-553-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist