Individual
MR. JASON LEIGH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.H.C.
Contact information
Practice address
505 5TH ST., SUITE 520, SIOUX CITY, IA 51101
(712) 259-2681
Mailing address
505 5TH ST., SUITE 520, SIOUX CITY, IA 51101
(712) 259-2681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001550
IA
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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