Basic Information
| Provider Information | |||||||||
| NPI: | 1114424793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEFEVER | ||||||||
| FirstName: | AUTUMN | ||||||||
| MiddleName: | RAYE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 DOMINION DR STE A | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540169333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514244000 | ||||||||
| FaxNumber: | 7158088533 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 DOMINION DR STE A | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540169333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514244000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2018 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 426-140 | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.