Individual
JENNIFER ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
700 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3082
(219) 218-7214
Mailing address
7607 ASHBY LANDINGS DR, UNIT 204, LOUISVILLE, KY 40272-7727
(219) 218-7214
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22005992A
IN
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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