Individual
JAMIE R WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, LPC, RPT-S
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3206-125
WI
101YP2500X
Professional Counselor
Primary
180033993
IL
101YP2500X
Professional Counselor
3206-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14270
DEAN INSURANCE
WI
01
—
180033993
LICENCED CLIN. PROF. COUN
IL
01
—
3206-125
LPC
WI
05
—
41000700
—
WI
Enumeration date
06/16/2006
Last updated
11/22/2023
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