Provider Demographics
NPI:1780969766
Name:WAGMAN, ROSE MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:WAGMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 LAKECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3015
Mailing Address - Country:US
Mailing Address - Phone:281-497-7254
Mailing Address - Fax:
Practice Address - Street 1:1419 LAKECLIFF DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3015
Practice Address - Country:US
Practice Address - Phone:281-497-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist