Individual
JENNIFER LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
800 W 5TH AVE, SUITE 205I, NAPERVILLE, IL 60563-8965
(630) 779-0751
Mailing address
800 W 5TH AVE, SUITE 205I, NAPERVILLE, IL 60563-8965
(630) 779-0751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
23972
IL
101YP2500X
Professional Counselor
Primary
180006579
IL
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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