Individual
MR. RANDALL L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6376
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6376
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3203-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063558211
—
WI
Enumeration date
01/29/2007
Last updated
12/15/2020
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