=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306794904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. WAGNER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2026
-----------------------------------------------------
Last Update Date | 03/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2035 COMMERCE DR STE 201
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46714-9295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-706-2558
-----------------------------------------------------
Fax | 260-565-3555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2035 COMMERCE DR STE 201
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46714-9295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-706-2558
-----------------------------------------------------
Fax | 260-565-3555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | JENNIFER L WAGNER
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 260-706-2558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------