Individual
ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
421 22ND ST S, LA CROSSE, WI 54601-5046
(608) 782-4575
Mailing address
421 22ND ST S, LA CROSSE, WI 54601-5046
(608) 782-4575
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
869-125
WI
1041C0700X
Clinical Social Worker
3214
WI
Other
Enumeration date
01/02/2007
Last updated
01/04/2010
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