Organization
LISA WAGNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA WAGNER MA, CCC-A (AUDIOLOGIST)
(517) 336-1940
Entity
Organization
Contact information
Practice address
455 E GRAND RIVER AVE, SUITE 204, BRIGHTON, MI 48116-1551
(810) 494-1700
(810) 494-0223
Mailing address
4970 NORTHWIND DR, SUITE 226, EAST LANSING, MI 48823-5080
(517) 336-1940
(517) 336-1944
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000283
MI
Other
Enumeration date
01/31/2011
Last updated
01/31/2011
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