Provider Demographics
NPI:1457927261
Name:JOHNSON, ABIGAIL CHRISINE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CHRISINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S MOORLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3720
Mailing Address - Country:US
Mailing Address - Phone:414-329-2500
Mailing Address - Fax:
Practice Address - Street 1:1445 N 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1063
Practice Address - Country:US
Practice Address - Phone:715-246-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-01-29
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2024-01-17
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI6466-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician