Individual
MRS. MACI WAGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSWA
Contact information
Practice address
1545 HARBECK RD, GRANTS PASS, OR 97527-5605
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L10399
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
—
Enumeration date
10/17/2016
Last updated
02/12/2024
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