Healthcare Provider Details

I. General information

NPI: 1639208630
Provider Name (Legal Business Name): ABIGAIL DENEE CLEVENGER RN, QMHS-BACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

IV. Provider business mailing address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9029
  • Fax:
Mailing address:
  • Phone: 330-264-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number529413
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: