Provider Demographics
NPI:1740565845
Name:WAGONER, JULIE KRISTEN (AUD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KRISTEN
Last Name:WAGONER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1305
Mailing Address - Country:US
Mailing Address - Phone:703-851-5301
Mailing Address - Fax:
Practice Address - Street 1:4660 KENMORE AVE STE 409
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-823-3336
Practice Address - Fax:703-823-4684
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001480237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter