Jacquelyn Wagner, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2978154 Issued in WI

Practice address

833 N 26TH St
Milwaukee, WI 53233-1507

Phone

(414) 344-7676

NPI assigned

Nov 13, 2006

Last updated

Sep 18, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221696000000",
    "number": "1134290935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 N 26TH STREET",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532334345",
            "telephone_number": "414-344-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 N 26TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532331507",
            "telephone_number": "414-344-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JACQUELYN",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2008-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.000217",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2978154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy J Wagner, MD
• Bailey Madeline Wagner
• Brett Wagner
• Christopher Joseph Wagner, DO
• Christopher Raymond Wagner, MD
• Kaitlyn Wagner, MD
• Kimberly Wagner, MSW
• Laura K Wagner, LCSW
• Nina E Wagner, CRNP
• Rachel Wagner

• Speech-Language Pathologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.