Healthcare Provider Details

I. General information

NPI: 1518560887
Provider Name (Legal Business Name): AUTUMN ELIZABETH HUGHES M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTHPARK BLVD # 102
ST AUGUSTINE FL
32086-3129
US

IV. Provider business mailing address

13756 HARLOWTON AVE
JACKSONVILLE FL
32256-6877
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-6236
  • Fax:
Mailing address:
  • Phone: 904-521-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9674
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: