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NPI Code Detail

MEDICARE: MRS. ABBIE ALICE BOLL CCC-SLP

MEDICARE: MRS. ABBIE ALICE BOLL CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistP8269AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134459522
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ABBIE ALICE BOLL CCC-SLP
Provider Business Mailing Address
First Line : 6208 W PERSIMMON ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72704-7054
Country : US
Telephone Number : 870-577-5854
Fax Number :
Provider Business Practice Location Address
First Line : 272 SCHOOL AVE
Second Line :
City : WEST FORK
State : AR
Zip : 72774-3124
Country : US
Telephone Number : 479-839-3349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2010
Last Update Date : 02/02/2023

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Directions to “ MRS. ABBIE ALICE BOLL CCC-SLP” Practice Location

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