Healthcare Provider Details

I. General information

NPI: 1003724121
Provider Name (Legal Business Name): ABBIGAIL GRACE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 LAKE UNDERHILL RD
ORLANDO FL
32807-1182
US

IV. Provider business mailing address

4780 DATA CT
ORLANDO FL
32817-8331
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-1942
  • Fax:
Mailing address:
  • Phone: 407-852-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: