Provider Demographics
NPI:1114619061
Name:WYATT, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SPRINGFIELD DR APT 157
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7314
Mailing Address - Country:US
Mailing Address - Phone:530-598-4832
Mailing Address - Fax:
Practice Address - Street 1:3435 SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0386
Practice Address - Country:US
Practice Address - Phone:530-774-2261
Practice Address - Fax:530-774-2378
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist