Basic Information
| Provider Information | |||||||||
| NPI: | 1386005494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLES | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | AVERETT | ||||||||
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| Credential: | M.ED., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | MEDICAL SERVICES BUILDING | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064757000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | MEDICAL SERVICES BUILDING | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064757000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2016 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP009185 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.