Provider Demographics
NPI:1508906108
Name:VOELLER, AMY CELEST (MED)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CELEST
Last Name:VOELLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1677
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1677
Mailing Address - Country:US
Mailing Address - Phone:208-664-1606
Mailing Address - Fax:208-664-9685
Practice Address - Street 1:421 E COEUR DALENE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1704
Practice Address - Country:US
Practice Address - Phone:208-664-1606
Practice Address - Fax:208-664-9685
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 1034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional