Individual
DONNA J WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16200 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1103
(586) 263-8998
(586) 412-7889
Mailing address
16200 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1103
(586) 263-8998
(586) 412-7889
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802015806
MI
Other
Enumeration date
03/30/2009
Last updated
03/30/2009
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