Provider Demographics
NPI:1962230136
Name:MENARD, AUTUMN ALEXANDRIA (SLP-CF)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ALEXANDRIA
Last Name:MENARD
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19411 MCKAY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5713
Mailing Address - Country:US
Mailing Address - Phone:281-446-2680
Mailing Address - Fax:
Practice Address - Street 1:19411 MCKAY DR STE 300
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5713
Practice Address - Country:US
Practice Address - Phone:281-446-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist