Provider Demographics
NPI:1750199394
Name:WAGENER, ISABELLE JANE
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:JANE
Last Name:WAGENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SE TALLGRASS LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-6804
Mailing Address - Country:US
Mailing Address - Phone:515-344-0059
Mailing Address - Fax:
Practice Address - Street 1:7951 EP TRUE PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8107
Practice Address - Country:US
Practice Address - Phone:515-223-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist