Healthcare Provider Details

I. General information

NPI: 1134066822
Provider Name (Legal Business Name): ABBIE GALE WILCOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROOD AVE STE 201
GRAND JUNCTION CO
81501-2761
US

IV. Provider business mailing address

1121 R RD
LOMA CO
81524-9560
US

V. Phone/Fax

Practice location:
  • Phone: 970-628-5695
  • Fax:
Mailing address:
  • Phone: 970-628-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number24487439
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: