Provider Demographics
NPI:1932888476
Name:MUCKENHIRN, AUTUMN LEA
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LEA
Last Name:MUCKENHIRN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3496
Mailing Address - Country:US
Mailing Address - Phone:630-442-4119
Mailing Address - Fax:
Practice Address - Street 1:1535 RIVER PARK DR STE 1000
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4601
Practice Address - Country:US
Practice Address - Phone:916-734-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist