Individual
STACEY BAGWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
1070 PARKVIEW ST, FENTON, MI 48430-4149
(810) 813-4240
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101000611
MI
Other
Enumeration date
06/08/2015
Last updated
04/08/2024
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