Provider Demographics
NPI:1841857497
Name:KELLY, ABIGAIL E
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:E
Last Name:KELLY
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 1:76 NORTHWOOD COMMONS PL
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7214
Mailing Address - Country:US
Mailing Address - Phone:530-513-3319
Mailing Address - Fax:
Practice Address - Street 1:1000 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5100
Practice Address - Country:US
Practice Address - Phone:530-533-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist