Healthcare Provider Details

I. General information

NPI: 1699334870
Provider Name (Legal Business Name): ABIGAIL FERTAL M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 STUBBS AVE
MONROE LA
71201-5629
US

IV. Provider business mailing address

1500 W KENTUCKY AVE
RUSTON LA
71270-9577
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-8414
  • Fax:
Mailing address:
  • Phone: 318-402-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: