Provider Demographics
NPI:1386954212
Name:O'NEAL, AUTUMN H (SLP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:H
Last Name:O'NEAL
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 1:3977 N CANAL RD
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-4864
Mailing Address - Country:US
Mailing Address - Phone:904-239-6613
Mailing Address - Fax:
Practice Address - Street 1:3977 N CANAL RD
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-4864
Practice Address - Country:US
Practice Address - Phone:904-239-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist