Individual
HOLLY J WAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSP, CCC-SLP
Contact information
Practice address
520 N BLACK AVE, BOZEMAN, MT 59715-3613
(704) 796-0610
Mailing address
520 N BLACK AVE, BOZEMAN, MT 59715-3613
(704) 796-0610
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA8682
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1206
LICENSE
MT
01
—
SA8682
SLP STATE LICENSE
FL
Enumeration date
09/20/2006
Last updated
02/06/2009
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