Individual
ALYSSA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3311
Mailing address
16490 OLD BEDFORD RD, NORTHVILLE, MI 48168-2067
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101004736
MI
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
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