Individual
JESSICA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
PO BOX 753, TROUTDALE, OR 97060-0753
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M5624
OR
1041C0700X
Clinical Social Worker
Primary
LW6055853
WA
Other
Enumeration date
08/28/2014
Last updated
08/22/2018
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