Provider Demographics
NPI:1619842614
Name:COULTAS, AMELIA NOELLE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:NOELLE
Last Name:COULTAS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8996 MIRAMAR RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4463
Mailing Address - Country:US
Mailing Address - Phone:760-688-0608
Mailing Address - Fax:
Practice Address - Street 1:8996 MIRAMAR RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4463
Practice Address - Country:US
Practice Address - Phone:760-688-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist