Provider Demographics
NPI:1679723332
Name:WAGNER, JOYCE (SLP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LAWRENCE BELL DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-204-0355
Mailing Address - Fax:716-204-0354
Practice Address - Street 1:80 LAWRENCE BELL DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-204-0355
Practice Address - Fax:716-204-0354
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014777-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist