Individual
LORI ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1385 MENDOTA HEIGHTS RD STE 200, MENDOTA HEIGHTS, MN 55120-1289
(651) 379-9800
Mailing address
1385 MENDOTA HEIGHTS RD STE 200, MENDOTA HEIGHTS, MN 55120-1289
(651) 379-9800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CC01011
MN
101YP2500X
Professional Counselor
Primary
CC01011
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538542246
—
MN
Enumeration date
06/30/2015
Last updated
03/17/2018
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