Provider Demographics
NPI:1134931231
Name:WAGENER, ABIGAIL MARIE (MS)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:WAGENER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4832
Mailing Address - Country:US
Mailing Address - Phone:847-648-1495
Mailing Address - Fax:
Practice Address - Street 1:1430 N BELMONT AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4832
Practice Address - Country:US
Practice Address - Phone:847-398-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2649741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist