Doctor Name: | MRS. AMANDA K. WAGNER |
NPI Number: | 1134183650 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 7019 |
Business Practice Address: | 1610 N Countyline St Fostoria, OH - 448301938 |
Business Phone Number: | 4194477203 |
Business Fax Number: | 4194475577 |
Mailing Address: | Po Box 833, TIFFIN |
State: | OH |
Postal Code: | 448830833 |
Phone Number: | 4194477203 |
Fax Number: | 4194475577 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |