Healthcare Provider Details

I. General information

NPI: 1235801150
Provider Name (Legal Business Name): ABIGAIL SANDS WILLIS OBRIEN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 06/13/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CORPORATE DR STE 101
KNOXVILLE TN
37923-4638
US

IV. Provider business mailing address

310 CORPORATE DR STE 101
KNOXVILLE TN
37923-4638
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-5622
  • Fax: 865-769-0801
Mailing address:
  • Phone: 601-433-3852
  • Fax: 865-769-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7660
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: