Individual
AUGUST BRUCE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 SW TAYLOR ST STE 200, PORTLAND, OR 97204-2446
(503) 446-2500
Mailing address
17570 NW CORNELL RD APT 7, BEAVERTON, OR 97006-8641
(970) 567-5203
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
R8260
OR
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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