Individual
JASON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2405 28TH ST, ANACORTES, WA 98221-2484
(360) 333-5684
Mailing address
2405 28TH ST, ANACORTES, WA 98221-2484
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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