Individual
AMANDA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7021 W 153RD ST STE 5, ORLAND PARK, IL 60462-5397
(708) 275-0934
(888) 419-1594
Mailing address
PO BOX 764, MANTENO, IL 60950-0764
(708) 275-0934
(888) 419-1594
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
208000757
IL
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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