Individual
MS. DIANE MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4701 VAN DORN ST, LINCOLN, NE 68506-2562
(402) 420-2650
Mailing address
4701 VAN DORN ST, LINCOLN, NE 68506-2562
(402) 420-2650
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4711
NE
1041C0700X
Clinical Social Worker
Primary
1625
NE
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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