Provider Demographics
NPI:1184092355
Name:LANDE, ABIGAIL GRAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRAY
Last Name:LANDE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:PAIGE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10889 WESTON DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9324
Mailing Address - Country:US
Mailing Address - Phone:317-506-6414
Mailing Address - Fax:
Practice Address - Street 1:10889 WESTON DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9324
Practice Address - Country:US
Practice Address - Phone:317-506-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006572A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist