Healthcare Provider Details

I. General information

NPI: 1992335459
Provider Name (Legal Business Name): AUTUMN MARIE HADDEN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 WV HIGHWAY 47 W
COXS MILLS WV
26342-8107
US

IV. Provider business mailing address

6326 WV HIGHWAY 47 W
COXS MILLS WV
26342-8107
US

V. Phone/Fax

Practice location:
  • Phone: 812-593-0635
  • Fax:
Mailing address:
  • Phone: 812-593-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL300987
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: