| Doctor Name: | MS. NICOLE A. M. WAGONHEIM |
| NPI Number: | 1407998651 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. CCC-SLP |
| License Number: | 02799 |
| Business Practice Address: | 7401 Osler Dr Suite 110 Towson, MD - 212047673 |
| Business Phone Number: | 4102968888 |
| Business Fax Number: | |
| Mailing Address: | 7455 Pinewild Rd, SEVEN VALLEYS |
| State: | PA |
| Postal Code: | 173609165 |
| Phone Number: | 7177280753 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 11/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 02799 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| 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 |