Individual
LILY S WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
7251 EXCELSIOR RD, BAXTER, MN 56425-8477
(218) 454-0878
Mailing address
PO BOX 2506, BAXTER, MN 56425-2506
(218) 454-0878
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24788
MN
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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