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Individual
ANDREA LOUISE WAGNER
Active
Individual
ANDREA LOUISE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
02206
MN
101YP2500X
Professional Counselor
Primary
02206
MN
101YP2500X
Professional Counselor
11724-125
WI
Other
Enumeration date
09/29/2020
Last updated
07/14/2026
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