Individual
MISS EMILY MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3823 N SOUTHPORT AVE, #2, CHICAGO, IL 60613-5933
(773) 633-3789
Mailing address
3823 N SOUTHPORT AVE, #2, CHICAGO, IL 60613-5933
(773) 633-3789
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146008770
IL
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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