Individual
TAYLOR MARIE VAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4160 OCOEE ST N, CLEVELAND, TN 37312-4885
(423) 506-6306
Mailing address
4160 OCOEE ST N, CLEVELAND, TN 37312-4885
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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