MEDICARE: ABIGAIL BAMBERG

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1427776749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL BAMBERG

Provider Business Mailing Address
First Line	:	2529 LA CHARLES DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 CANDELARIA RD NE STE E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1953
Country	:	US
Telephone Number	:	505-675-0689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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Directions to “ ABIGAIL BAMBERG ” Practice Location

Language	Start Address	Practice Location

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