Provider Demographics
NPI:1659834679
Name:WAGENER, ANNEMARIE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:
Last Name:WAGENER
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 DRIVER RD.
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104
Mailing Address - Country:US
Mailing Address - Phone:410-490-4441
Mailing Address - Fax:
Practice Address - Street 1:870 DRIVER RD.
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104
Practice Address - Country:US
Practice Address - Phone:410-490-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist