Individual
TERRI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1000 N 92ND ST, WAUWATOSA, WI 53226-3533
(414) 479-9364
Mailing address
2527 N 113TH ST, WAUWATOSA, WI 53226-1215
(414) 303-1501
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2252-154
WI
Other
Enumeration date
07/03/2007
Last updated
07/08/2007
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