Amanda L Wagner, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146008923 Issued in IL

Practice address

1025 Maine St
Quincy, IL 62301-4038

Phone

(217) 222-6550

Fax

(217) 277-2253

NPI assigned

Jun 24, 2010

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

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quincy Physicians & Surgeons Clinic, PLLC

  • Clinic/Center
  • Quincy, IL
  • NPI 1548234198
  Medicare reassignment NPD
• Quincy Physicians & Surgeons Clinic, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Pittsfield, IL
  • NPI 1871794925
  NPD
• Quincy Physicians & Surgeons Clinic, PLLC

  dba Quncy Medical Group Pharmacy

  • Pharmacy
  • Quincy, IL
  • NPI 1417921560
  NPD (past)

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306108800000",
    "number": "1679884696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "AMANDA",
        "middle_name": "L",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-24",
        "last_updated": "2011-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146008923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey A. Vonderhaar, SLP
• Amy Kathleen Voss, MS, QMHP
• John Vu
• John L Wachtel, PT
• Jodie M Wadsworth, O.D.
• Dennis Ryan Wagner, DMD
• Wal-Mart Stores, Inc (Vision Center 30-1454)
• Deedria Waldrop
• Walgreen Co (Walgreens Prescription Cener #21168)
• Walgreen Co (Walgreens #15249)

• Speech-Language Pathologist in Quincy, IL
• Providers in Quincy, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.