Individual
MS. JEANIE WAGENER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MS, CCC
Contact information
Practice address
1010 WASHINGTON ST, VANCOUVER, WA 98660-3167
(360) 699-6374
Mailing address
1010 WASHINGTON ST, VANCOUVER, WA 98660-3167
(360) 699-6374
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00001505
WA
Other
Enumeration date
11/04/2005
Last updated
07/08/2007
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