Individual
MRS. MICHELLE RENE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS-CCC-SLP
Contact information
Practice address
1401 CHURCHILL ST, WAUPACA, WI 54981-2027
(715) 258-8131
(715) 258-0179
Mailing address
8670 4TH ST, ALMOND, WI 54909-9027
(715) 366-2508
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2230-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42796300
—
WI
Enumeration date
05/03/2007
Last updated
07/08/2007
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