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Individual
SAMANTHA WAGNER
Active
Individual
SAMANTHA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178016407
IL
Other
Enumeration date
05/15/2021
Last updated
05/15/2021
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