Individual
ELISABETH P WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3737 W 4100 S, WEST VALLEY CITY, UT 84120-5543
(888) 949-4864
(206) 901-2010
Mailing address
3725 W 4100 S STE 201, SALT LAKE CITY, UT 84120-5411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9443009-6004
UT
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/26/2020
Last updated
02/25/2025
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