| Doctor Name: | GRETCHEN ELIZABETH WAGNER |
| NPI Number: | 1881821627 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 3389 |
| Business Practice Address: | 1732 Deroche Cir Suite B Gramercy, LA - 700523548 |
| Business Phone Number: | 2258680309 |
| Business Fax Number: | 2258690271 |
| Mailing Address: | 311 S River Pointe, LA PLACE |
| State: | LA |
| Postal Code: | 700682958 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/19/2009 |
| NPI Last Update Date: | 06/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3389 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| 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 |