Individual
ELIZABETH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC ATR-BC
Contact information
Practice address
105 N FAIR ST, CHAMPAIGN, IL 61821
(217) 398-8090
Mailing address
105 N FAIR ST, CHAMPAIGN, IL 61821-3130
(217) 398-8090
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.003668
IL
101YP2500X
Professional Counselor
180.003668
IL
Other
Enumeration date
04/18/2007
Last updated
11/18/2025
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