Provider Demographics
NPI:1881410900
Name:MOSLEY, AUTUMN ROSE (SLP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ROSE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2452
Mailing Address - Country:US
Mailing Address - Phone:541-653-5658
Mailing Address - Fax:
Practice Address - Street 1:2615 LONE OAK WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2554
Practice Address - Country:US
Practice Address - Phone:541-579-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty