Individual
MRS. CHERYL LEA WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC LICENSED MENTAL
Contact information
Practice address
1308 BRANDON WAY, FORT WAYNE, IN 46845-2381
(260) 244-3427
Mailing address
1308 BRANDON WAY, FORT WAYNE, IN 46845-2381
(260) 244-3427
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001832A
IN
Other
Enumeration date
12/18/2007
Last updated
11/18/2009
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