Individual
MRS. ELLEN CHIFICI VAN WAGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
36515 MANCHAC TRACE AVE, PRAIRIEVILLE, LA 70769-3223
(225) 333-0685
Mailing address
36515 MANCHAC TRACE AVE, PRAIRIEVILLE, LA 70769-3223
(225) 333-0685
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4776
LA
Other
Enumeration date
03/30/2011
Last updated
03/30/2011
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