Individual
MISS EMILY GRACE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT-C
Contact information
Practice address
11720 PLAZA AMERICA DR FL 9, RESTON, VA 20190-4757
(866) 968-7512
Mailing address
11720 PLAZA AMERICA DR FL 9, RESTON, VA 20190-4757
(866) 968-7512
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
NA
—
2355S0801X
Speech-Language Assistant
29001978A
IN
Other
Enumeration date
08/27/2018
Last updated
07/31/2023
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