Individual
MS. NICOLE A. M. WAGONHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
7401 OSLER DR, SUITE 110, TOWSON, MD 21204-7673
(410) 296-8888
Mailing address
7455 PINEWILD RD, SEVEN VALLEYS, PA 17360-9165
(717) 728-0753
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
02799
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
613155
BC BS
MD
Enumeration date
02/13/2007
Last updated
11/22/2011
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