Basic Information
Provider Information | |||||||||
NPI: | 1598927485 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOLSIEFER | ||||||||
FirstName: | AMBER | ||||||||
MiddleName: | SADENWATER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AU.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SADENWATER | ||||||||
OtherFirstName: | AMBER | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | B.S. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1100 REID PKWY | ||||||||
Address2: | MEDICAL STAFF SERVICES | ||||||||
City: | RICHMOND | ||||||||
State: | IN | ||||||||
PostalCode: | 473741157 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7659358806 | ||||||||
FaxNumber: | 7659833219 | ||||||||
Practice Location | |||||||||
Address1: | 11201 GUY ST | ||||||||
Address2: |   | ||||||||
City: | FISHERS | ||||||||
State: | IN | ||||||||
PostalCode: | 460385453 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8123201959 | ||||||||
FaxNumber: | 8123201959 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2008 | ||||||||
LastUpdateDate: | 09/30/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/30/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 23002520A | IN | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
ID Information
ID | Type | State | Issuer | Description | 201112650 | 05 | IN |   | MEDICAID | 0101994 | 05 | OH |   | MEDICAID | 000000857273 | 01 | IN | ANTHEM | OTHER |