Provider Demographics
NPI:1386868099
Name:WAGNER, JOYCE RACHEL (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:RACHEL
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23435 ASTER WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-6149
Mailing Address - Country:US
Mailing Address - Phone:240-317-5279
Mailing Address - Fax:
Practice Address - Street 1:1 MAGNOLIA
Practice Address - Street 2:ATTENTION REHAB
Practice Address - City:LAPLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-934-4001
Practice Address - Fax:301-934-4580
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist