Individual
KATELYN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 LANGDON ST, SPARTANBURG, SC 29302-1614
(719) 210-8194
Mailing address
4042 WALLOON LN APT 311, SPARTANBURG, SC 29301-6626
(719) 210-8194
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
17154
SC
Other
Enumeration date
08/10/2021
Last updated
09/10/2024
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