Individual
MRS. SUSAN CAROL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1108 DITHRIDGE DR, JOHNSTOWN, PA 15905-1503
(814) 255-7907
(814) 255-7907
Mailing address
1108 DITHRIDGE DR, JOHNSTOWN, PA 15905-1503
(814) 255-7907
(814) 255-7907
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW004045E
PA
Other
Enumeration date
11/08/2010
Last updated
11/08/2010
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