Provider Demographics
NPI:1831738285
Name:DUNHAM, ABBI KEZIAH (SLP)
Entity type:Individual
Prefix:
First Name:ABBI
Middle Name:KEZIAH
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ABBI
Other - Middle Name:KEZIAH
Other - Last Name:MACHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 N 19TH ST APT 411
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1319
Mailing Address - Country:US
Mailing Address - Phone:218-230-1721
Mailing Address - Fax:
Practice Address - Street 1:119 N 19TH ST APT 411
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1319
Practice Address - Country:US
Practice Address - Phone:218-230-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist