Active NPI
Anne Wagner, MS
- Speech-Language Pathologist
- Antioch, IL
National Provider Identifier
1871372151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2625595
- Practice address
- 800 Highview Dr
Antioch, IL 60002-1141 - Phone
- (847) 838-8369
- NPI assigned
- Sep 26, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 2625595 | IL | Primary |
Addresses
Primary practice location
800 Highview Dr
Antioch, IL 60002-1141
Mailing address
935 Deer Path Dr
Antioch, IL 60002-2499
Phone (224) 456-0128
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2625595 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1871372151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 DEER PATH DR",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600022499",
"telephone_number": "224-456-0128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 HIGHVIEW DR",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600021141",
"telephone_number": "847-838-8369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ANNE",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-26",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "2625595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.