Individual
KEELI NICOLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-1669
Mailing address
2530 CHICAGO AVE # CSC175, MINNEAPOLIS, MN 55404-4289
(612) 813-7411
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
20422
MN
Other
Enumeration date
08/28/2019
Last updated
04/01/2025
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