Individual
MRS. ANNIE STAGNER WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8388
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8388
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
164756
KY
Other
Enumeration date
01/29/2015
Last updated
11/10/2016
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