Provider Demographics
NPI:1780419101
Name:PRYOR, ABIGAIL LEIGH (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEIGH
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-8599
Mailing Address - Country:US
Mailing Address - Phone:870-615-9051
Mailing Address - Fax:
Practice Address - Street 1:1201 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2081
Practice Address - Country:US
Practice Address - Phone:224-303-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL242.008044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program