Kelley Wagner, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

112685 Issued in TX

Practice address

9201 Brodie LN Unit 2601
Austin, TX 78748-6290

Phone

(512) 517-3906

NPI assigned

Aug 14, 2018

Last updated

Aug 14, 2018By 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 1

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": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1376023986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 BRODIE LN UNIT 2601",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486290",
            "telephone_number": "512-517-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 BRODIE LN UNIT 2601",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486290",
            "telephone_number": "512-517-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KELLEY",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-14",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "112685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Robert Wagner, D.C.
• Elizabeth Marie Wagner
• Jennifer Wagner, LCSW
• Jessica Mae Wagner
• Karen Kay Wagner, PT
• Leon R Wagner, DC
• Nicholas J. Wagner, MD
• Rebecca Ann Wagner, PHD
• Sarah Elizabeth Rene Wagner, LPC
• Tara T Wagner, M.D.

• Speech-Language Pathologist in Austin, TX
• Providers in Austin, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.