Provider Demographics
NPI:1356169510
Name:FERNANDES, ABBEY MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:MARIE
Last Name:FERNANDES
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 1:510 MITCHELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUGHESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:570-905-6246
Mailing Address - Fax:
Practice Address - Street 1:510 MITCHELL DRIVE
Practice Address - Street 2:
Practice Address - City:HUGHESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-905-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist