Provider Demographics
NPI:1558035840
Name:TRACY, AUTUMN HAYLEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:HAYLEY
Last Name:TRACY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:HUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 E FLORIDA AVE STE 917
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2549
Mailing Address - Country:US
Mailing Address - Phone:844-757-7450
Mailing Address - Fax:
Practice Address - Street 1:3801 E FLORIDA AVE STE 917
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2549
Practice Address - Country:US
Practice Address - Phone:844-757-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist