Individual
LANNIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
(815) 233-6167
Mailing address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
(815) 233-6167
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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