Autumn Vivienne Falk-O'Denius, LAC LMP

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC61413207 Issued in WA

Practice address

9123 271St NW
S
Stanwood, WA 98292

Phone

(425) 530-0594

Fax

(360) 659-3918

NPI assigned

Apr 4, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mrs. Autumn Odenius Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1053433599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 181",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "98292",
            "telephone_number": "425-530-0594",
            "fax_number": "360-659-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9123 271ST NW",
            "address_2": "S",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "98292",
            "telephone_number": "425-530-0594",
            "fax_number": "360-659-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALK-O'DENIUS",
        "first_name": "AUTUMN",
        "middle_name": "VIVIENNE",
        "name_prefix": "Mrs.",
        "credential": "LAC LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC61413207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA",
            "identifier": "364802001",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "108835",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "ODENIUS",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Joy R Fackenthall, MD
• Brandon Jayson Falk, D.C.
• Bambe Gassama Fatty
• Phyllis A Ferguson, ARNP
• Cody E Finks, DPT
• Alexandra Catherine Marie Fiola

• Acupuncturist in Stanwood, WA
• Providers in Stanwood, WA by specialty
• Acupuncturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.