Provider Demographics
NPI:1750128153
Name:REILLY-ECKSTROM, ABIGAIL ERIN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:ERIN
Last Name:REILLY-ECKSTROM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1713
Mailing Address - Country:US
Mailing Address - Phone:814-323-9671
Mailing Address - Fax:
Practice Address - Street 1:105 WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1713
Practice Address - Country:US
Practice Address - Phone:814-323-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01752235Z00000X
PASL016790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist