Provider Demographics
NPI:1598329500
Name:WAGSTER, ADRIENNE KATHLEEN
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:KATHLEEN
Last Name:WAGSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4486
Mailing Address - Country:US
Mailing Address - Phone:561-376-2573
Mailing Address - Fax:
Practice Address - Street 1:5589 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4486
Practice Address - Country:US
Practice Address - Phone:561-376-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty