Healthcare Provider Details

I. General information

NPI: 1497682108
Provider Name (Legal Business Name): ABIGAIL WIATT MS. CCC-SLP,SERVICES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 FLORY AVE
MOORPARK CA
93021-1819
US

IV. Provider business mailing address

642 SPRING OAK RD UNIT 1312
CAMARILLO CA
93010-7552
US

V. Phone/Fax

Practice location:
  • Phone: 805-378-6311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: