Autumn Henderson, M. ED

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

11632 W Santa Barbara Dr
Boise, ID 83709-6638

Phone

(208) 340-5677

NPI assigned

Jun 28, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1477230795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11632 W SANTA BARBARA DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096638",
            "telephone_number": "208-340-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11632 W SANTA BARBARA DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096638",
            "telephone_number": "208-340-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "AUTUMN",
        "credential": "M. ED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael L Henbest, MD
• Kerry Sean Hendershot, LPC
• Nicole Hendershot, OTR/L
• Henderson Chiropractic PLLC
• Andrea J Henderson, PT
• Jenna Kaitlyn Henderson, DPT
• Jessica Berry Henderson, PH.D., L.P.C
• Jessica D Henderson, LCSW
• Joan Marie Henderson, EDD
• Lindsay Henderson

• Developmental Therapist in Boise, ID
• Providers in Boise, ID by specialty
• Developmental Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.