MEDICARE: ABIGAIL ELIZABETH BALL 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	200956	AR

General Provider Information

NPI Number	:	1649851304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ELIZABETH BALL SLP

Provider Business Mailing Address
First Line	:	6705 W 12TH ST STE 3
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1568
Country	:	US
Telephone Number	:	501-603-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	6705 W 12TH ST STE 3
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1568
Country	:	US
Telephone Number	:	501-603-9976
Fax Number	:

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

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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