Provider Demographics
NPI:1548978547
Name:BALLARD, ABIGAIL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BALLARD
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 1:3677 OLD HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:RUSH SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:73082-2459
Mailing Address - Country:US
Mailing Address - Phone:580-251-0984
Mailing Address - Fax:
Practice Address - Street 1:3677 OLD HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:RUSH SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:73082-2459
Practice Address - Country:US
Practice Address - Phone:580-251-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist