MEDICARE: MR. JAY A. WAGNER M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL006248L	PA

General Provider Information

NPI Number	:	1033483300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY A. WAGNER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1830 BUTERBAUGH RD
Second Line	:
City	:	CHERRY TREE
State	:	PA
Zip	:	15724-9746
Country	:	US
Telephone Number	:	724-309-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 BUTERBAUGH RD
Second Line	:
City	:	CHERRY TREE
State	:	PA
Zip	:	15724-9746
Country	:	US
Telephone Number	:	724-309-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2012
Last Update Date	:	03/03/2012

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Directions to “ MR. JAY A. WAGNER M.S. CCC-SLP” Practice Location

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