Provider Demographics
NPI:1679721542
Name:GREENE, AUTUMN SHAREE (CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:SHAREE
Last Name:GREENE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 RITTENHOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1850
Mailing Address - Country:US
Mailing Address - Phone:717-364-8735
Mailing Address - Fax:
Practice Address - Street 1:507 RITTENHOUSE SQ
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1850
Practice Address - Country:US
Practice Address - Phone:717-364-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12147245OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
PASL009354OtherSTATE BOARD OF SPEECH-LANGUAGE AND HEARING EXAMINERS