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JEREMY MICHAEL WAGONER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1300 ANDREA ST, SUITE 205, BOWLING GREEN, KY 42104-3382
(270) 904-2260
(270) 781-9680
Mailing address
1300 ANDREA ST, SUITE 205, BOWLING GREEN, KY 42104-3382
(270) 904-2260
(270) 781-9680

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3958
KY

Other

Enumeration date
01/20/2015
Last updated
01/20/2015
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