MEDICARE: ABIGAIL BALLARD MA, 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
1	235Z00000X	Speech-Language Pathologist	5082	OK

General Provider Information

NPI Number	:	1548978547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL BALLARD MA, CCC-SLP

Provider Business Mailing Address
First Line	:	3677 OLD HIGHWAY 81
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-2459
Country	:	US
Telephone Number	:	580-251-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3677 OLD HIGHWAY 81
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-2459
Country	:	US
Telephone Number	:	580-251-0984
Fax Number	:

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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Directions to “ ABIGAIL BALLARD MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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