Active NPI
Kaitlynn Nicole Wagner, CCC-SLP
- Speech-Language Pathologist
- Alexandria, VA
National Provider Identifier
1871239293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 031767
- Practice address
- 900 Virginia Ave
Alexandria, VA 22302-3200 - Phone
- (703) 684-9100
- NPI assigned
- May 9, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 031767 | NY | Primary |
Addresses
Primary practice location
900 Virginia Ave
Alexandria, VA 22302-3200
Mailing address
306 Alverson Ave
Staten Island, NY 10309-1787
Phone (347) 215-0165
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031767 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652054400000",
"number": "1871239293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 ALVERSON AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103091787",
"telephone_number": "347-215-0165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 VIRGINIA AVE",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223023200",
"telephone_number": "703-684-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KAITLYNN",
"middle_name": "NICOLE",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-09",
"last_updated": "2022-05-09",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "031767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.