Active NPI
Deborah Wagner, M.S. CCC-SLP
- Speech-Language Pathologist
- Lytle, TX
National Provider Identifier
1922736933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 19279
- Practice address
- 19126 Prairie St
Lytle, TX 78052-3495 - Phone
- (210) 885-8214
- NPI assigned
- Aug 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 | 19279 | TX | Primary |
Addresses
Primary practice location
19126 Prairie St
Lytle, TX 78052-3495
Mailing address
PO Box 1510
Lytle, TX 78052-1510
Phone (210) 885-8214
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 |
|---|---|---|---|
| 19279 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1922736933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1510",
"city": "LYTLE",
"state": "TX",
"postal_code": "780521510",
"telephone_number": "210-885-8214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19126 PRAIRIE ST",
"city": "LYTLE",
"state": "TX",
"postal_code": "780523495",
"telephone_number": "210-885-8214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DEBORAH",
"name_prefix": "Mrs.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-09",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "19279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lytle, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.