Provider Demographics
NPI:1225805625
Name:WEGNER, AMELIA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:WEGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1139 MARRON CIR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5031
Mailing Address - Country:US
Mailing Address - Phone:352-263-1621
Mailing Address - Fax:
Practice Address - Street 1:1800 OLD PECOS TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4759
Practice Address - Country:US
Practice Address - Phone:505-424-8777
Practice Address - Fax:505-424-9777
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist