Organization
CAROLYN WAGNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN WAGNER (PSYCHOTHERAPIST)
(847) 728-8148
Entity
Organization
Contact information
Practice address
1159 WILMETTE AVE STE 225, WILMETTE, IL 60091-2653
(847) 728-8148
Mailing address
1159 WILMETTE AVE STE 225, WILMETTE, IL 60091-2653
(847) 728-8148
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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