Individual
SCOTT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A. CCC-SLP
Contact information
Practice address
5045 KENNELWOOD DR, SAINT LOUIS, MO 63129-2424
(314) 852-5282
Mailing address
5045 KENNELWOOD DR, SAINT LOUIS, MO 63129-2424
(314) 852-5282
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
104180
MO
Other
Enumeration date
11/27/2015
Last updated
11/27/2015
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