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Individual

CAROLYN WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A., CCC-SLP

Contact information

Practice address
24498 OAK VALLEY LN, HOLLYWOOD, MD 20636-2304
(516) 633-3592
Mailing address
24498 OAK VALLEY LN, HOLLYWOOD, MD 20636-2304
(516) 633-3592

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11225
MD
235Z00000X
Speech-Language Pathologist
6121
SC

Other

Enumeration date
09/30/2016
Last updated
12/12/2024
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