Individual
ALIX VITACCO WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPSC
Contact information
Practice address
1777 WEST AVE, SANTA ROSA, CA 95407-7449
(707) 546-7050
(707) 546-0434
Mailing address
1777 WEST AVE, SANTA ROSA, CA 95407-7449
(707) 546-7050
(707) 546-0434
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
CA
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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