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NPI Code Detail

MEDICARE: ABIGAIL TACKETT

MEDICARE: ABIGAIL TACKETT
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 Pathologist

General Provider Information

NPI Number : 1801727722
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL TACKETT
Provider Business Mailing Address
First Line : 456 N WISCONSIN ST
Second Line :
City : BERLIN
State : WI
Zip : 54923-1104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3109 MOUNT PLEASANT ST
Second Line :
City : RACINE
State : WI
Zip : 53404-1511
Country : US
Telephone Number : 262-634-6303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ ABIGAIL TACKETT ” Practice Location

Language Start Address Practice Location
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