Individual
KELLY JEAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4301 SERGEANT RD, STE 203, SIOUX CITY, IA 51106-4710
(712) 276-9000
(712) 276-4917
Mailing address
230 9TH AVE N, FORT DODGE, IA 50501-2411
(515) 573-3138
(515) 573-3130
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00850
IA
Other
Enumeration date
08/10/2009
Last updated
08/10/2009
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