Individual
MIA WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30903 W 10 MILE RD STE B, FARMINGTON HILLS, MI 48336-2615
(248) 893-6192
Mailing address
17260 HANOVER AVE, ALLEN PARK, MI 48101-2835
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7152000746
MI
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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