Active NPI
Jeanie Wagener, MS, CCC
- Speech-Language Pathologist
- Vancouver, WA
National Provider Identifier
1053302299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL00001505
- Practice address
- 1010 Washington St
Vancouver, WA 98660-3167 - Phone
- (360) 699-6374
- NPI assigned
- Nov 4, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | LL00001505 | WA | Primary |
Addresses
Primary practice location
1010 Washington St
Vancouver, WA 98660-3167
Mailing address
1010 Washington St
Vancouver, WA 98660-3167
Phone (360) 699-6374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL00001505 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1053302299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 WASHINGTON ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603167",
"telephone_number": "360-699-6374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 WASHINGTON ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603167",
"telephone_number": "360-699-6374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENER",
"first_name": "JEANIE",
"name_prefix": "Ms.",
"credential": "MS, CCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-04",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL00001505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.