Provider Demographics
NPI:1275915456
Name:RINGEISEN, AUTUMN LEANN (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:AUTUMN
Middle Name:LEANN
Last Name:RINGEISEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411169
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1169
Mailing Address - Country:US
Mailing Address - Phone:888-830-4125
Mailing Address - Fax:
Practice Address - Street 1:2108 E BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2401
Practice Address - Country:US
Practice Address - Phone:765-416-8480
Practice Address - Fax:765-588-5480
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist