Provider Demographics
NPI:1922563477
Name:TULLOS MCLAWCHLIN, ABBY
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:TULLOS MCLAWCHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:GRACE
Other - Last Name:TULLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 SAND FOX RUN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:817 SAND FOX RUN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3145
Practice Address - Country:US
Practice Address - Phone:318-235-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA006769507OtherDRIVERS LICENSE