Individual
MS. ELISE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPC, AAC
Contact information
Practice address
3754 W INDIAN TRAIL RD, SPOKANE, WA 99208-4700
(328) 704-1509
Mailing address
3754 W INDIAN TRAIL RD, SPOKANE, WA 99208-4700
(328) 704-1509
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG60841239
WA
175T00000X
Peer Specialist
Primary
—
WA
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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