Provider Demographics
NPI:1699653600
Name:MOORE, ABIGAIL LACEY (SLP)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:LACEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2726
Mailing Address - Country:US
Mailing Address - Phone:708-776-3927
Mailing Address - Fax:
Practice Address - Street 1:4100 JOLIET AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1513
Practice Address - Country:US
Practice Address - Phone:708-783-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242008634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist