Individual
CAROLYN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1159 WILMETTE AVE, SUITE 225, WILMETTE, IL 60091-2649
(847) 728-8148
Mailing address
116 ELMORE ST, PARK RIDGE, IL 60068-3520
(847) 728-8148
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.008548
IL
101YP2500X
Professional Counselor
Primary
180.013022
IL
Other
Enumeration date
04/19/2017
Last updated
07/23/2020
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