Provider Demographics
NPI:1184823460
Name:WAGNON, CECILIA ANN (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANN
Last Name:WAGNON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 ORANGE TREE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4619
Mailing Address - Country:US
Mailing Address - Phone:903-641-2589
Mailing Address - Fax:
Practice Address - Street 1:400 PANTHER LANE
Practice Address - Street 2:
Practice Address - City:MAYPEARL
Practice Address - State:TX
Practice Address - Zip Code:76064-0040
Practice Address - Country:US
Practice Address - Phone:972-435-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist