Provider Demographics
NPI:1912914011
Name:WUSTERBARTH, AMY LYNNE (AUD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:WUSTERBARTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MACK BAYOU LOOP STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7194
Mailing Address - Country:US
Mailing Address - Phone:850-622-0996
Mailing Address - Fax:850-622-1185
Practice Address - Street 1:141 MACK BAYOU LOOP STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7194
Practice Address - Country:US
Practice Address - Phone:850-622-0996
Practice Address - Fax:850-622-1185
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1719231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist