Provider Demographics
NPI:1679789630
Name:WAGNER, MEGAN MARKS (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARKS
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5042 MEADOWSIDE CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5959
Mailing Address - Country:US
Mailing Address - Phone:513-779-0995
Mailing Address - Fax:
Practice Address - Street 1:281 N FAIR AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4242
Practice Address - Country:US
Practice Address - Phone:513-868-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist