1629822325 NPI number — AUTUMN AMBER SLOCUM MS, CCC-SLP

Table of content: AUTUMN AMBER SLOCUM MS, CCC-SLP (NPI 1629822325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629822325 NPI number — AUTUMN AMBER SLOCUM MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOCUM
Provider First Name:
AUTUMN
Provider Middle Name:
AMBER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIS
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
AMBER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629822325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 77TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98270-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-831-2604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 91ST AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-334-4071
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL61460706 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com