Provider Demographics
NPI:1881067890
Name:POWNER, AMBER MARJORIE (AUD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARJORIE
Last Name:POWNER
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 1:2001 PINER RD
Mailing Address - Street 2:APT 229
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-6958
Mailing Address - Country:US
Mailing Address - Phone:707-523-4740
Mailing Address - Fax:
Practice Address - Street 1:1111 SONOMA AVE STE 316
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4820
Practice Address - Country:US
Practice Address - Phone:707-523-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3005237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter