Provider Demographics
NPI:1952744047
Name:WIRTH, ABIGAIL JAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JAN
Last Name:WIRTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DARGIE LN
Mailing Address - Street 2:
Mailing Address - City:EAST RYEGATE
Mailing Address - State:VT
Mailing Address - Zip Code:05042-8970
Mailing Address - Country:US
Mailing Address - Phone:802-757-3469
Mailing Address - Fax:
Practice Address - Street 1:55 DARGIE LN
Practice Address - Street 2:
Practice Address - City:EAST RYEGATE
Practice Address - State:VT
Practice Address - Zip Code:05042-8970
Practice Address - Country:US
Practice Address - Phone:802-757-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist