Provider Demographics
NPI:1629824321
Name:BELLONI, AUTUMN RACHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:RACHELLE
Last Name:BELLONI
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 1:420 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2228
Mailing Address - Country:US
Mailing Address - Phone:541-574-2240
Mailing Address - Fax:
Practice Address - Street 1:420 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2228
Practice Address - Country:US
Practice Address - Phone:541-574-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist