Provider Demographics
NPI:1982116406
Name:CULHANE, AUTUMN A
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:A
Last Name:CULHANE
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 1:16585 474TH AVE
Mailing Address - Street 2:
Mailing Address - City:STRANDBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57265-6501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 8TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3507
Practice Address - Country:US
Practice Address - Phone:605-696-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD749-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist