Individual
LAUREN E WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5638 PROFESSIONAL CIR, INDIANAPOLIS, IN 46241
(888) 714-1927
(317) 745-9565
Mailing address
5101 E US HIGHWAY 36 STE 100, AVON, IN 46123-6646
(888) 714-1927
(317) 745-9565
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376006178(008)
—
IL
Enumeration date
09/21/2016
Last updated
09/16/2019
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