Healthcare Provider Details

I. General information

NPI: 1427979921
Provider Name (Legal Business Name): AUTUMN A HUBBARD SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 MAE DELL RD
CHATTANOOGA TN
37421-2455
US

IV. Provider business mailing address

PO BOX 8114
CHATTANOOGA TN
37414-0114
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-1551
  • Fax:
Mailing address:
  • Phone: 423-622-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9339
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: