Individual
DR. KIMBERLY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
201 N ROSE AVE, ROOM 32, BLOOMINGTON, IN 47405-1005
(812) 856-8572
Mailing address
2401 E 8TH ST, BLOOMINGTON, IN 47408-4212
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
20042059A
IN
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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