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NPI Code Detail

MEDICARE: ABIGAIL ANDERSEN BOURSIQUOT CCC-SLP

MEDICARE: ABIGAIL ANDERSEN BOURSIQUOT 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
1235Z00000XSpeech-Language Pathologist146.015797IL

General Provider Information

NPI Number : 1659863702
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL ANDERSEN BOURSIQUOT CCC-SLP
Provider Business Mailing Address
First Line : 2869 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2869 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4201
Country : US
Telephone Number : 733-665-9947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2018
Last Update Date : 10/05/2022

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Directions to “ ABIGAIL ANDERSEN BOURSIQUOT CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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