Provider Demographics
NPI:1912629882
Name:JOHNS, ABIGAIL (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:536 STIRLING BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5294
Mailing Address - Country:US
Mailing Address - Phone:470-429-1842
Mailing Address - Fax:
Practice Address - Street 1:1000 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4629
Practice Address - Country:US
Practice Address - Phone:951-294-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist