Carly Marie Wagner, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3781 Issued in WI

Practice address

742 Sterbenz Dr
St Croix Therapy
Hudson, WI 54016-8327

Phone

(715) 386-2128

Fax

(715) 386-6119

NPI assigned

Mar 15, 2013

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

Other identifiers 1

Other names 1

• Carly Marie Sjodin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

88.63 of 100Reported as group

Quality

75.41

Promoting interoperability

100

Improvement activities

40

Cost

75.75

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Fairview Express Care

  dba M Health Fairview Recovery Clinic

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  NPD
• Fairview Express Care

  dba M Health Fairview Heart Clinic - Fridley

  • Cardiovascular Disease Physician
  • Fridley, MN
  • NPI 1144616509
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Healtheast Outpatient Services, LLC

  • Physical Therapist
  • Saint Paul, MN
  • NPI 1225382526

  Speech-Language Pathologist

  NPD
• Optage Inc

  dba Presbyterian Homes and Services Rehabilitation

  • Rehabilitation Clinic/Center
  • Mahtomedi, MN
  • NPI 1699464149

  Speech-Language Pathologist

  NPD
• Optage Inc

  dba Eaglecrest

  • Rehabilitation Clinic/Center
  • Roseville, MN
  • NPI 1801517230

  Speech-Language Pathologist

  NPD
• Optage Inc

  dba Lexington Landing

  • Rehabilitation Clinic/Center
  • Saint Paul, MN
  • NPI 1982393518

  Speech-Language Pathologist

  NPD
• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD (past)

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

{
    "created_epoch": "1363305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1457692428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 STERBENZ DR",
            "address_2": "ST CROIX THERAPY",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168327",
            "telephone_number": "715-386-2128",
            "fax_number": "715-386-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 STERBENZ DR",
            "address_2": "ST CROIX THERAPY",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168327",
            "telephone_number": "715-386-2128",
            "fax_number": "715-386-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CARLY",
        "middle_name": "MARIE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-15",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "3781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE",
            "identifier": "3781",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "SJODIN",
            "middle_name": "MARIE",
            "credential": "MS, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Anne Verga, DC
• Savanna Vevang
• Andrew R Virata, M.D.
• Virginia Vogel
• Danielle A Wacker, OTR/L
• Jacqueline Rae Wagner, OTR/L
• Cortney Kim Wakefield, OTR/L
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1365)
• Jeryn Lee Waldera, BCBA
• Zachary Walgenbach, D.D.S.

• Speech-Language Pathologist in Hudson, WI
• Providers in Hudson, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.