Provider Demographics
NPI:1598927485
Name:WOLSIEFER, AMBER SADENWATER (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:SADENWATER
Last Name:WOLSIEFER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:SADENWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8806
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:11201 GUY ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-5453
Practice Address - Country:US
Practice Address - Phone:812-320-1959
Practice Address - Fax:812-320-1959
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002520A231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201112650Medicaid
OH0101994Medicaid
IN000000857273OtherANTHEM
OH0101994Medicaid