Provider Demographics
NPI:1073036034
Name:ARENDT, AUTUMN RAE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:RAE
Last Name:ARENDT
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65967 430TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAZEPPA
Mailing Address - State:MN
Mailing Address - Zip Code:55956-4102
Mailing Address - Country:US
Mailing Address - Phone:507-696-2994
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5503
Practice Address - Country:US
Practice Address - Phone:507-977-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist