Elizabeth Crossley Wagner

Key facts

NPI

1336814409

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

22040006-42 (VA)

Practice address

7114 Cople Hwy
Hague, VA 22469-2525

Phone

(804) 440-1489

NPI assigned

Aug 11, 2021

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Talk Therapy Services, LLC Speech-Language Pathologist · Richmond, VA · NPI 1811573140
  NPD SPEECH-LANGUAGE PATHOLOGIST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 11, 2021.

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1336814409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5004 MONUMENT AVE STE 104",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232303629",
            "telephone_number": "804-440-1489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7114 COPLE HWY",
            "city": "HAGUE",
            "state": "VA",
            "postal_code": "224692525",
            "telephone_number": "804-440-1489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "454 Oak Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Colonial Beach",
            "state": "VA",
            "postal_code": "224435501",
            "country_code": "US",
            "telephone_number": "804-440-4546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24667 The Trl",
            "address_purpose": "LOCATION",
            "city": "Mattaponi",
            "state": "VA",
            "postal_code": "231102037",
            "country_code": "US",
            "telephone_number": "804-440-1489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELIZABETH",
        "middle_name": "CROSSLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "22040006-42",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Hague, VA · Speech-Language Pathologist in Virginia