Individual
KELSEY WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S GARDEN WAY APT 9, EUGENE, OR 97401-5909
(503) 312-9800
Mailing address
101 S GARDEN WAY APT 9, EUGENE, OR 97401-5909
(503) 312-9800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/21/2012
Last updated
06/24/2013
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