Healthcare Provider Details

I. General information

NPI: 1710414776
Provider Name (Legal Business Name): LAUREN ABERNETHY M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2017
Last Update Date: 05/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 KIRBY LOOP RD
FORT PIERCE FL
34981-5345
US

IV. Provider business mailing address

2721 OAK ALLEY DR
FORT PIERCE FL
34981-5083
US

V. Phone/Fax

Practice location:
  • Phone: 772-577-6964
  • Fax: 772-577-6964
Mailing address:
  • Phone: 321-368-1032
  • Fax: 772-461-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA13240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: