Provider Demographics
NPI:1811683204
Name:WISSNER, AUTUMN MARIE (CF-SLP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:MARIE
Last Name:WISSNER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3258
Mailing Address - Country:US
Mailing Address - Phone:989-948-6494
Mailing Address - Fax:
Practice Address - Street 1:2000 ALDER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3258
Practice Address - Country:US
Practice Address - Phone:989-948-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK205097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist