Provider Demographics
NPI:1730647629
Name:OUELLETTE, AMELIA WITTWER
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:WITTWER
Last Name:OUELLETTE
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 1:33720 NE KRAMIEN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7017
Mailing Address - Country:US
Mailing Address - Phone:503-577-4198
Mailing Address - Fax:
Practice Address - Street 1:2855 HAYES ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1397
Practice Address - Country:US
Practice Address - Phone:503-901-5652
Practice Address - Fax:888-587-8510
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty