Amanda Wagner
Individual provider Active NPI Speech-Language Pathologist · Deforest, WI
NPI 1376475053 · NPPES record last updated May 29, 2026
Key facts
- NPI
- 1376475053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- Dahs 815 Jefferson Street
Deforest, WI 53532 - Phone
- (608) 516-1461
- NPI assigned
- May 29, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
Dahs 815 Jefferson Street
Deforest, WI 53532
Mailing address
Dahs 815 Jefferson Street
Deforest, WI 53532
Phone (608) 516-1461
Other providers in Deforest, WI
- John Joseph Tuten
- Everett Vang
- Cally Vaughn
- Jennifer A Victor
- Paul Villarreal
- Dolores Wasylik
- Morgan Wochinski
- Jennifer Lynn Wyrick
- Shannon Elizabeth Young
All providers in Deforest, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.