Individual
NICHOLAS WAGENSELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
449 PRIM ST, ASHLAND, OR 97520-1555
(203) 451-0485
Mailing address
449 PRIM ST, ASHLAND, OR 97520-1555
(203) 451-0485
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5989
OR
Other
Enumeration date
01/26/2021
Last updated
01/26/2021
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