MEDICARE: MRS. AUTUMN DAWN ANDERSON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	902-SLP	SD

General Provider Information

NPI Number	:	1811500598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUTUMN DAWN ANDERSON CCC-SLP

Provider Business Mailing Address
First Line	:	1817 VALLEY DR
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2041
Country	:	US
Telephone Number	:	605-723-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 VALLEY DR
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2041
Country	:	US
Telephone Number	:	605-723-3382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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Directions to “ MRS. AUTUMN DAWN ANDERSON CCC-SLP” Practice Location

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