Provider Demographics
NPI:1629822325
Name:SLOCUM, AUTUMN AMBER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:AMBER
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:AMBER
Other - Last Name:WEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6410 77TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-9201
Mailing Address - Country:US
Mailing Address - Phone:360-831-2604
Mailing Address - Fax:
Practice Address - Street 1:402 91ST AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2530
Practice Address - Country:US
Practice Address - Phone:425-334-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61460706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist