Individual
MRS. LISA DIANNE WENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
600 MEDICAL DR, WENTZVILLE, MO 63385-3426
(636) 327-1332
Mailing address
1531 E SUNSHINE ST STE W29, SPRINGFIELD, MO 65804-1237
(417) 887-9550
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2008008554
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008008554
PROFESSIONAL REGISTRATION
MO
Enumeration date
03/29/2008
Last updated
12/05/2019
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