Individual
MR. BRANDAL J WAGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
4620 E 53RD ST STE 200, DAVENPORT, IA 52807-3627
(224) 216-4209
Mailing address
4620 E 53RD ST STE 200, DAVENPORT, IA 52807-3627
(224) 216-4209
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
093843
IA
Other
Enumeration date
08/18/2019
Last updated
02/26/2023
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