Individual
KATHRYN E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCPSLP
Contact information
Practice address
11711 S VINE ST, JENKS, OK 74037-4343
(918) 289-1667
Mailing address
11711 S VINE ST, JENKS, OK 74037-4343
(918) 289-1667
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3019
OK
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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