Healthcare Provider Details

I. General information

NPI: 1760846646
Provider Name (Legal Business Name): AUTUMN MURDOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6979 TEAYS VALLEY RD
SCOTT DEPOT WV
25560-7097
US

IV. Provider business mailing address

PO BOX 977
HURRICANE WV
25526-0977
US

V. Phone/Fax

Practice location:
  • Phone: 681-235-7156
  • Fax: 800-901-7511
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0989
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: