Individual
JENNIFER RAE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LAT
Contact information
Practice address
507 S MONROE ST, LANCASTER, WI 53813-2054
(608) 723-3236
(608) 723-3379
Mailing address
507 S MONROE ST, LANCASTER, WI 53813-2054
(608) 723-3236
(608) 723-3379
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1002-39
WI
Other
Enumeration date
03/20/2006
Last updated
04/16/2014
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