Individual
MRS. LISA LOUISE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-A
Contact information
Practice address
5040 VILLA LINDE PKWY STE A, FLINT, MI 48532-3445
(810) 732-4250
(810) 732-0444
Mailing address
5040 VILLA LINDE PKWY STE A, FLINT, MI 48532-3445
(810) 732-4250
(810) 732-0444
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000283
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578731725
—
MI
Enumeration date
02/11/2008
Last updated
02/27/2020
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