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Organization
WAGNER COUNSELING PLLC SAMANTHA WAGNER SOLE MBR
Active
Organization
WAGNER COUNSELING PLLC SAMANTHA WAGNER SOLE MBR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATTY NUNEZ (CREDENTIALING SPECIALIST)
(312) 439-2321
Entity
Organization
Contact information
Practice address
112 N 2ND ST, ROCKFORD, IL 61107-4051
(608) 313-4655
Mailing address
112 N 2ND ST, ROCKFORD, IL 61107-4051
(608) 313-4655
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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