Provider Demographics
NPI:1407507395
Name:TENNEY, AUTUMN ROSE (MSW/MLS/LBS)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:ROSE
Last Name:TENNEY
Suffix:
Gender:F
Credentials:MSW/MLS/LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1070
Mailing Address - Country:US
Mailing Address - Phone:412-389-2654
Mailing Address - Fax:
Practice Address - Street 1:90 W CHESTNUT ST STE 117UL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4532
Practice Address - Country:US
Practice Address - Phone:724-229-0311
Practice Address - Fax:724-229-3277
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000506222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist