Provider Demographics
NPI:1841586716
Name:MASTER, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:MASTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC MS-SLP
Mailing Address - Street 1:464 2ND ST
Mailing Address - Street 2:STE 105
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1963
Mailing Address - Country:US
Mailing Address - Phone:952-401-4242
Mailing Address - Fax:
Practice Address - Street 1:464 2ND ST
Practice Address - Street 2:STE 105
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1963
Practice Address - Country:US
Practice Address - Phone:952-401-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist