Individual
MR. JACOB ARNOLD WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSP, ED.S
Contact information
Practice address
2292 CHAMBLISS AVE NW STE C2, CLEVELAND, TN 37311-3862
(423) 479-5672
(423) 479-5679
Mailing address
2292 CHAMBLISS AVE NW STE C2, CLEVELAND, TN 37311-3862
(423) 479-5672
(423) 479-5679
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
—
—
103TS0200X
School Psychologist
Primary
000748846
TN
Other
Enumeration date
06/25/2024
Last updated
06/25/2024
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