Individual
CARLY MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
742 STERBENZ DR, ST CROIX THERAPY, HUDSON, WI 54016-8327
(715) 386-2128
(715) 386-6119
Mailing address
742 STERBENZ DR, ST CROIX THERAPY, HUDSON, WI 54016-8327
(715) 386-2128
(715) 386-6119
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3781
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3781
WISCONSIN LICENSE
WI
Enumeration date
03/15/2013
Last updated
09/16/2013
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