Individual
AMANDA L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
(217) 277-2253
Mailing address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
(217) 277-2253
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146008923
IL
Other
Enumeration date
06/24/2010
Last updated
05/23/2011
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