Individual
ERICA Y WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
552 N COLORADO ST, STE. 200, KENNEWICK, WA 99336-7779
(509) 736-6060
(509) 736-3939
Mailing address
4208 MEADOWVIEW DR, PASCO, WA 99301-9523
(509) 543-9224
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00016506
WA
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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