Individual
BETTY LOUISE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
251 NE GARDEN VALLEY BLVD STE B, ROSEBURG, OR 97470
(309) 360-7749
Mailing address
251 NE GARDEN VALLEY BLVD STE B, ROSEBURG, OR 97470-2085
(541) 579-8100
(541) 981-5103
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801081590
MI
1041C0700X
Clinical Social Worker
Primary
L7525
OR
Other
Enumeration date
01/22/2007
Last updated
01/15/2021
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