Provider Demographics
NPI:1154529402
Name:WAGNER BERMAN, JOSI AMANDA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOSI
Middle Name:AMANDA
Last Name:WAGNER BERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:626 GOLDEN EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0909
Mailing Address - Country:US
Mailing Address - Phone:303-883-2293
Mailing Address - Fax:866-543-7981
Practice Address - Street 1:626 GOLDEN EAGLE CIR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-0909
Practice Address - Country:US
Practice Address - Phone:303-883-2293
Practice Address - Fax:866-543-7981
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12040893235Z00000X
CO0000037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000037OtherCOLORADO LICENSE #
CO30-0124329OtherTLC SPEECH THERAPY, INC.
CO03051781Medicaid
AL12040893OtherAMERICAN SPEECH LANGUAGE