Individual
KRISTEN G WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1595 S CALUMET RD, SUITE #3, CHESTERTON, IN 46304-2388
(219) 763-6858
Mailing address
902 ASPEN ST, HEBRON, IN 46341-9087
(219) 996-7590
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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