Individual
PATTI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1701 SHARP RD, WATERFORD, WI 53185-5214
(920) 531-2662
Mailing address
E7475 RAWHIDE RD, NEW LONDON, WI 54961-9025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5837-125
WI
Other
Enumeration date
10/11/2017
Last updated
12/31/2024
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