Individual
DR. JEROME PETER WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2603 BROADWAY AVE, EVANSTON, IL 60201-1501
(847) 492-1690
Mailing address
2603 BROADWAY AVE, EVANSTON, IL 60201-1501
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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