Provider Demographics
NPI:1992363063
Name:PETERMANN, ABIGAYL MARIE HOCKETT (SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAYL
Middle Name:MARIE HOCKETT
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ABIGAYL
Other - Middle Name:MARIE
Other - Last Name:HOCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4417 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8331
Mailing Address - Country:US
Mailing Address - Phone:918-397-7588
Mailing Address - Fax:
Practice Address - Street 1:1223 SWAN DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5037
Practice Address - Country:US
Practice Address - Phone:918-336-8500
Practice Address - Fax:918-336-8519
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4320235Z00000X
OK5169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist