Individual
AMANDA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 SE 5TH AVE, APT 223, BOCA RATON, FL 33432-5072
(570) 573-0258
Mailing address
120 SE 5TH AVE, APT 223, BOCA RATON, FL 33432-5072
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA11554
FL
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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