Healthcare Provider Details

I. General information

NPI: 1699682971
Provider Name (Legal Business Name): PAIGE ELIZABETH WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9937 HIGHWAY 12 SW
ROCHESTER WA
98579-9601
US

IV. Provider business mailing address

19949 TEA ST SW
ROCHESTER WA
98579-9397
US

V. Phone/Fax

Practice location:
  • Phone: 360-273-5958
  • Fax:
Mailing address:
  • Phone: 360-880-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPI.SI.70135676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: