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General NPI Number Information
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NPI Number | 1275904609
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Entity Type | Organization
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Legal Business Name | AUTASTIC AVENUES LLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 1301 ROBIN HOOD ROAD
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City | RICHMOND
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State | VA
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Zip | 23227
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Country | US
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Telephone | 804-301-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 5911 WILLOW CREEK WAY
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City | RICHMOND
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State | VA
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Zip | 23225
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Country | US
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Telephone | 804-301-8428
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Fax |
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | MS. ROBIN MCCALLISTER
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Credential | MA, CCC-SLP
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Telephone | 804-301-8428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202001777
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License Number State | VA
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