Provider Demographics
NPI:1518560887
Name:HUGHES, AUTUMN ELIZABETH (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ELIZABETH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13756 HARLOWTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6877
Mailing Address - Country:US
Mailing Address - Phone:904-521-7999
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTHPARK BLVD # 102
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3129
Practice Address - Country:US
Practice Address - Phone:904-417-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9674235Z00000X
FLSA19389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist