Individual
ANNE BACON WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
7905 N MEADOWLARK WAY, SUITE C, COEUR D ALENE, ID 83815-5041
(208) 762-3979
(208) 762-4419
Mailing address
7905 N MEADOWLARK WAY, SUITE C, COEUR D ALENE, ID 83815-5041
(208) 762-3979
(208) 762-4419
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-779
ID
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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