Autumn Kallock

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2656 Issued in ND

Practice address

1420 4TH Ave NW
East Grand Forks, MN 56721-1522

Phone

(218) 773-3494

NPI assigned

Jul 1, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Little Miracles, Inc.

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1821110982
  Medicare reassignment NPD
• Polk County Auditor

  • Public Health or Welfare Agency
  • Crookston, MN
  • NPI 1538225065
  NPD (past)

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776124800000",
    "number": "1538905427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2951 S 34TH ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016061",
            "telephone_number": "701-772-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 4TH AVE NW",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211522",
            "telephone_number": "218-773-3494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Library Cir",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582016326",
            "country_code": "US",
            "telephone_number": "701-757-2155",
            "fax_number": "701-757-2156",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2951 S 34th St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582016061",
            "country_code": "US",
            "telephone_number": "701-772-3851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALLOCK",
        "first_name": "AUTUMN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "2656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE SLP LICENSE",
            "identifier": "2656",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Jean Jeffrey Brown, OTR/L
• Craig Alan Johnson, DDS
• Karen Johnsonatkinson, RN
• Brady Junes, MD
• Laurie T Jung, PT
• Sean Christian Karpowich, PHARMD
• Dylan Kent, PT, DPT
• Vanida Khamvongsa
• Joshua P Klabunde
• Brianna Kathleen Kral

• Speech-Language Pathologist in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.