Individual
TRACY WAGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
5 TROTTER CT, LUGOFF, SC 29078-8734
(803) 408-0701
(803) 408-0701
Mailing address
5 TROTTER CT, LUGOFF, SC 29078-8734
(803) 408-0701
(803) 408-0701
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3641
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0591
—
SC
Enumeration date
06/20/2013
Last updated
06/20/2013
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