Healthcare Provider Details

I. General information

NPI: 1790187409
Provider Name (Legal Business Name): ABBIGAIL EMILIE LAKE MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBIGAIL EMILIE STEWART

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 OAKVIEW RD
ASHLAND KY
41101-3677
US

IV. Provider business mailing address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-5200
  • Fax:
Mailing address:
  • Phone: 877-508-3237
  • Fax: 877-508-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPLPA00210182
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: