Provider Demographics
NPI:1497597488
Name:WIESER, ABIGAIL (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:WIESER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 GRAND AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAND MEADOW
Mailing Address - State:MN
Mailing Address - Zip Code:55936-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 GRAND AVE E
Practice Address - Street 2:
Practice Address - City:GRAND MEADOW
Practice Address - State:MN
Practice Address - Zip Code:55936-2600
Practice Address - Country:US
Practice Address - Phone:507-754-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist