Individual
LISA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSE
Contact information
Practice address
1136 WESTOWNE DR, NEENAH, WI 54956-2175
(920) 456-2030
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 456-2030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
7208
WI
101YP2500X
Professional Counselor
Primary
7208
WI
101YP2500X
Professional Counselor
7208-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100084556
—
WI
05
—
1407270465
—
WI
Enumeration date
02/12/2014
Last updated
07/05/2024
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