Provider Demographics
NPI:1992335459
Name:HADDEN, AUTUMN MARIE (IBCLC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:MARIE
Last Name:HADDEN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 TOWNSHIP ROAD 179
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9226
Mailing Address - Country:US
Mailing Address - Phone:812-593-0635
Mailing Address - Fax:
Practice Address - Street 1:5280 TOWNSHIP ROAD 179
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9226
Practice Address - Country:US
Practice Address - Phone:812-593-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL300987174N00000X
OH374J00000X
175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula