Active NPI
Amanda Wagner
- Speech-Language Pathologist
- Boca Raton, FL
National Provider Identifier
1295090504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA11554
- Practice address
- 120 SE 5TH Ave
Apt 223
Boca Raton, FL 33432-5072 - Phone
- (570) 573-0258
- NPI assigned
- Jul 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | SA11554 | FL | Primary |
Addresses
Primary practice location
120 SE 5TH Ave
Apt 223
Boca Raton, FL 33432-5072
Mailing address
120 SE 5TH Ave
Apt 223
Boca Raton, FL 33432-5072
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA11554 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342051200000",
"number": "1295090504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 SE 5TH AVE",
"address_2": "APT 223",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 SE 5TH AVE",
"address_2": "APT 223",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325072",
"telephone_number": "570-573-0258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-12",
"last_updated": "2012-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA11554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.