Healthcare Provider Details

I. General information

NPI: 1144561465
Provider Name (Legal Business Name): ABBY HABICHT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MAPLE ST. H 102
COLUMBIA SC
29205
US

IV. Provider business mailing address

705 MAPLE ST H 102
COLUMBIA SC
29205-1752
US

V. Phone/Fax

Practice location:
  • Phone: 419-308-6438
  • Fax:
Mailing address:
  • Phone: 419-308-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4700
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: