Doctor Name: | MISS MARITA LOANE WAGNER |
NPI Number: | 1144501446 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | SL002107L |
Business Practice Address: | 114 W Allens Ln Philadelphia, PA - 191194102 |
Business Phone Number: | 2152474034 |
Business Fax Number: | |
Mailing Address: | 114 W Allens Ln, PHILADELPHIA |
State: | PA |
Postal Code: | 191194102 |
Phone Number: | 2152474034 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2011 |
NPI Last Update Date: | 08/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SL002107L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
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 |