Provider Demographics
NPI:1356899868
Name:WAGNER, JAIME VICTORIA (SLP)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:VICTORIA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:VICTORIA
Other - Last Name:CATOGGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-542-3288
Mailing Address - Fax:302-542-3312
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-542-3288
Practice Address - Fax:302-542-3312
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010314235Z00000X
DEO1-0001197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist