| Doctor Name: | MRS. MIRIAM ELIZABETH WAGNER |
| NPI Number: | 1720367147 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC-SLP |
| License Number: | 4351 |
| Business Practice Address: | 301 Pinehaven Street Ext Laurens, SC - 293602671 |
| Business Phone Number: | 8649846584 |
| Business Fax Number: | 8649846464 |
| Mailing Address: | 301 Pinehaven Street Ext, LAURENS |
| State: | SC |
| Postal Code: | 293602671 |
| Phone Number: | 8649846584 |
| Fax Number: | 8649846464 |
| NPI Enumeration Date: | 08/16/2011 |
| NPI Last Update Date: | 04/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 4351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |