Individual
MISS WAYLEE LANE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 MAIN ST, GLASTONBURY, CT 06033-2218
(860) 430-1762
Mailing address
2300 MAIN ST, GLASTONBURY, CT 06033-2218
(860) 430-1762
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
18.007625
CT
Other
Enumeration date
06/09/2019
Last updated
01/17/2024
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