Individual
AMALYA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
9526 SHERMER RD, MORTON GROVE, IL 60053-1167
(847) 208-8744
Mailing address
9526 SHERMER RD, MORTON GROVE, IL 60053-1167
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146011676
IL
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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