MEDICARE: STEPHANIE 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	SLP11394	AZ

General Provider Information

NPI Number	:	1487139242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WAGNER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	12234 MENSA CT
Second Line	:
City	:	BELLEMONT
State	:	AZ
Zip	:	86015-5097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 N. FOURTH ST
Second Line	:	#481
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-8600
Country	:	US
Telephone Number	:	928-226-1563
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	12/04/2025

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Directions to “ STEPHANIE WAGNER M.S. CCC-SLP” Practice Location

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