Individual
JOHANNA LINNEA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
112 THREE WEST PKWY, VILLA RICA, GA 30180-4778
(770) 459-6533
(770) 462-1260
Mailing address
112 THREE WEST PKWY, VILLA RICA, GA 30180-4778
(770) 459-6533
(770) 462-1260
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
PCET003613
GA
235Z00000X
Speech-Language Pathologist
Primary
SLP012557
GA
Other
Enumeration date
06/21/2022
Last updated
05/16/2023
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