MEDICARE: ABBEY D ABRAHAM M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.14548	OH
2	235Z00000X	Speech-Language Pathologist	2202012396	VA

General Provider Information

NPI Number	:	1457028557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY D ABRAHAM M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	700 S ILLINOIS AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S ILLINOIS AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1835
Country	:	US
Telephone Number	:	419-522-4319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	04/24/2026

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