Provider Demographics
NPI:1144971888
Name:SAWYER, ALEXIS AUTUMN (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:AUTUMN
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 JUDSON STREET RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3944
Mailing Address - Country:US
Mailing Address - Phone:315-869-6178
Mailing Address - Fax:
Practice Address - Street 1:29 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1787
Practice Address - Country:US
Practice Address - Phone:315-265-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031298-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist