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Individual

KRISTA CLARICE AGLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200912670A
IN
Enumeration date
01/17/2014
Last updated
06/27/2014
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