Individual
LANDI GAYLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
100 KENDALL DR, LAMAR, CO 81052
(719) 336-7501
(719) 336-7453
Mailing address
711 BARNES AVE, LA JUNTA, CO 81050
(719) 384-5446
(719) 384-5672
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/24/2008
Last updated
10/08/2012
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