Individual
JEAN L. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E.1200270
OH
104100000X
Social Worker
S.0025485
OH
Other
Enumeration date
06/20/2013
Last updated
04/22/2021
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