Individual
MS. LISA COLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCC/SLP
Contact information
Practice address
8733 HOLLY SPRINGS RD, APEX, NC 27539-9194
(919) 981-6588
(919) 981-6255
Mailing address
4923 BERRY ROSE WAY, CARY, NC 27518-9266
(919) 796-2833
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
Primary
3874
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138GX
BLUE CROSS BLUE SHEILD #
NC
05
—
7211627
—
NC
Enumeration date
05/17/2006
Last updated
11/06/2024
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