Individual
MRS. MIRIAM ELIZABETH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
301 PINEHAVEN STREET EXT, LAURENS, SC 29360-2671
(864) 984-6584
(864) 984-6464
Mailing address
301 PINEHAVEN STREET EXT, LAURENS, SC 29360-2671
(864) 984-6584
(864) 984-6464
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4351
SC
Other
Enumeration date
08/16/2011
Last updated
04/30/2013
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