Individual
SAMANTHA DYAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
215 W LINN ST, NORMAN, OK 73069-5837
(405) 321-0022
(405) 360-4918
Mailing address
3124 W ROCK CREEK RD APT 102, NORMAN, OK 73072-2431
(405) 321-0022
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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