Provider Demographics
NPI:1881844298
Name:WHITE, AMY ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:WUSSTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:9300 W. STOCKTON BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-627-1494
Mailing Address - Fax:916-897-8853
Practice Address - Street 1:9300 W. STOCKTON BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-627-1494
Practice Address - Fax:916-897-8853
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2591231H00000X
CAHA 7412237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter