Individual
JACQUELINE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP/L
Contact information
Practice address
1640 N WELLS ST, SUITE 103, CHICAGO, IL 60614-6087
(312) 642-4300
Mailing address
1640 N WELLS ST, SUITE 103, CHICAGO, IL 60614-6087
(312) 642-4300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146009849
IL
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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