Provider Demographics
NPI:1194910521
Name:HASS, AUTUMN KATHLEEN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:KATHLEEN
Last Name:HASS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:KATHLEEN
Other - Last Name:HASS-ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:928 W LEWISTON AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1285
Mailing Address - Country:US
Mailing Address - Phone:248-496-0905
Mailing Address - Fax:
Practice Address - Street 1:928 W LEWISTON AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1285
Practice Address - Country:US
Practice Address - Phone:248-496-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist