Provider Demographics
NPI:1942821095
Name:WEALD, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEALD
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 1:2584 NW POMPY PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6734
Mailing Address - Country:US
Mailing Address - Phone:408-393-3231
Mailing Address - Fax:
Practice Address - Street 1:2584 NW POMPY PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6734
Practice Address - Country:US
Practice Address - Phone:408-393-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health