Individual
JONATHAN ERIC WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
2270 FORD PKWY STE 106, SAINT PAUL, MN 55116-3412
(612) 915-0049
Mailing address
2270 FORD PKWY STE 106, SAINT PAUL, MN 55116-3412
(612) 915-0049
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
02291
MN
101YP2500X
Professional Counselor
Primary
4525
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02291
STATE OF MINNESOTA
MN
Enumeration date
02/23/2021
Last updated
05/01/2025
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