Individual
DEBORAH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Mailing address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12904
—
104100000X
Social Worker
127241
—
1041C0700X
Clinical Social Worker
Primary
7536
—
Other
Enumeration date
11/23/2009
Last updated
11/23/2009
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