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Individual

JANA WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
811 WOODLAND RD, WAUCONDA, IL 60084-1476
(847) 772-7997
Mailing address
811 WOODLAND RD, WAUCONDA, IL 60084-1476
(847) 772-7997

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary

Other

Enumeration date
02/26/2021
Last updated
02/26/2021
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