Individual
MS. MICHELLE DEAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,L.P.C., B.C.P.C
Contact information
Practice address
833 BROADWAY ST, SUITE 103, CAPE GIRARDEAU, MO 63701-5515
(573) 332-7889
(573) 332-7889
Mailing address
1806 NORTHBRIDGE ST, CAPE GIRARDEAU, MO 63701-2532
(573) 332-7889
(573) 332-7889
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2001012922
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
495017337
—
MO
Enumeration date
06/29/2007
Last updated
07/08/2007
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