Individual
JODY LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
204 MARKET STREET, DENTON, MD 21629
(410) 479-3146
Mailing address
300 BLUE HERON DRIVE, UNIT 2, REHOBOTH, DE 19971
(443) 239-9001
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
02569
MD
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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