Basic Information
| Provider Information | |||||||||
| NPI: | 1336433986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINSELMAN | ||||||||
| FirstName: | AUTUMN | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7025 REED CT | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046620563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5437 EISENHAUER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782183757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106469576 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 05/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 106131 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 4547 | SC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 9097 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 314000000X | 106131 | TX | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.