Marita Loane Wagner, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL002107L Issued in PA

Practice address

114 W Allens LN
Philadelphia, PA 19119-4102

Phone

(215) 247-4034

NPI assigned

Aug 31, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1144501446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W ALLENS LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191194102",
            "telephone_number": "215-247-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 W ALLENS LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191194102",
            "telephone_number": "215-247-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARITA",
        "middle_name": "LOANE",
        "name_prefix": "Miss",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL002107L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason E Wagner, MD
• Jesse Wagner, MD
• Julia Wagner, MSW, LSW
• Kristina Marie Wagner, MD
• Lauren Ashley Wagner, RN
• Mark S. Wagner, PH.D.
• Laila Wah, OMD
• Ahmed Wahaj
• Ihab Michel Wahba, MD
• Ayesha Waheed, MD

• Speech-Language Pathologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; 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.