Individual
JESSICA SUSAN WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1435 VILLAGE DR, DEPT. 2801, OGDEN, UT 84408-2801
(801) 626-6000
Mailing address
1435 VILLAGE DR, DEPT. 2801, OGDEN, UT 84408-2801
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/22/2014
Last updated
06/01/2015
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