Provider Demographics
NPI:1366519308
Name:WOLBRECHT, AMIE LYNN (SP)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:LYNN
Last Name:WOLBRECHT
Suffix:
Gender:F
Credentials:SP
Other - Prefix:MISS
Other - First Name:AMIE
Other - Middle Name:LYNN
Other - Last Name:OLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SP
Mailing Address - Street 1:3200 BRISTOL ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1808
Mailing Address - Country:US
Mailing Address - Phone:714-557-9292
Mailing Address - Fax:714-557-9137
Practice Address - Street 1:3200 BRISTOL ST
Practice Address - Street 2:SUITE 180
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1808
Practice Address - Country:US
Practice Address - Phone:714-557-9292
Practice Address - Fax:714-557-9137
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 13681OtherSP LICENSE