Audrey Wagner, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL60973136 Issued in WA

Practice address

34515 9TH Ave S
Federal Way, WA 98003-6761

Phone

(253) 944-7970

NPI assigned

Aug 20, 2018

Last updated

Nov 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Audrey Eubanks Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Birth to Three Developmental Center

  • Physical Therapy Clinic/Center
  • Federal Way, WA
  • NPI 1609936624
  NPD (past)

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1750861639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35535 6TH AVE SW",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980238110",
            "telephone_number": "253-874-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34515 9TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036761",
            "telephone_number": "253-944-7970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 S J St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054933",
            "country_code": "US",
            "telephone_number": "253-426-6729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "AUDREY",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60973136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "EUBANKS",
            "credential": "MS, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rhoda Wangui Wachira
• Kathleen Patricia Waddell, FNP
• Matthew Gary Waddingham, CO
• Caitlin Wade, LMFTA
• Emily Wagler, DPM
• Kaitlin Wagner, DPT
• Sara Jagels Wagner, PA-C
• Kenneth Gitahi Wahu
• Julia Wakeham, MS, LMFT
• Wal-Mart Stores, Inc (Wal-Mart Vision Center 30-3794)

• Speech-Language Pathologist in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; 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.