Provider Demographics
NPI:1801654850
Name:PICKETT, ABBEY (CF-SLP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E 300 N APT A
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4013
Mailing Address - Country:US
Mailing Address - Phone:801-419-8257
Mailing Address - Fax:
Practice Address - Street 1:392 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3373
Practice Address - Country:US
Practice Address - Phone:208-749-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist