Individual
TANA J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
206 PORT NEAL RD, SERGEANT BLUFF, IA 51054-8098
(712) 943-3837
Mailing address
4417 LOST MEADOWS RD, SIOUX CITY, IA 51108-1001
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00852
IA
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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