| Doctor Name: | JACQUELYN WAGNER |
| NPI Number: | 1134290935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC-SLP |
| License Number: | 242.000217 |
| Business Practice Address: | 833 N 26th St Milwaukee, WI - 532331507 |
| Business Phone Number: | 4143447676 |
| Business Fax Number: | |
| Mailing Address: | 833 N 26th Street, MILWAUKEE |
| State: | WI |
| Postal Code: | 532334345 |
| Phone Number: | 4143447676 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 09/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 242.000217 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| 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 |