Provider Demographics
NPI:1447766951
Name:VOLZ WAGSTAFF, LEDONNE MARIE (LBSC)
Entity Type:Individual
Prefix:
First Name:LEDONNE
Middle Name:MARIE
Last Name:VOLZ WAGSTAFF
Suffix:
Gender:F
Credentials:LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2580
Mailing Address - Country:US
Mailing Address - Phone:610-769-4111
Mailing Address - Fax:
Practice Address - Street 1:2106 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3957
Practice Address - Country:US
Practice Address - Phone:610-349-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty