Individual
JOSEPH HERMAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ST
Contact information
Practice address
9445 LITZSINGER RD, SAINT LOUIS, MO 63144-2113
(314) 968-2350
Mailing address
1223 WEATHERTON PL, BALLWIN, MO 63021-7439
(636) 391-7643
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01668
MO
Other
Enumeration date
06/11/2007
Last updated
07/09/2007
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