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Individual

DR. IVY CHRISTINE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DBH, LCSW

Contact information

Practice address
780 2ND ST SE STE 10, BANDON, OR 97411-8354
(541) 329-2144
Mailing address
790 BLUFF AVE SW, BANDON, OR 97411-9614
(503) 984-9243

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L11519
OR

Other

Enumeration date
11/21/2017
Last updated
08/16/2024
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