| Wagner Counseling Pllc Samantha Wagner Sole Mbr | |
|
112 N 2nd St Rockford IL 61107-4051 | |
| (608) 313-4655 | |
| Not Available |
| Full Name | Wagner Counseling Pllc Samantha Wagner Sole Mbr |
|---|---|
| Speciality | Social Worker |
| Location | 112 N 2nd St, Rockford, Illinois |
| Authorized Official Name and Position | Patty Nunez (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3124392321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Counseling Pllc Samantha Wagner Sole Mbr 112 N 2nd St Rockford IL 61107-4051 Ph: (608) 313-4655 | Wagner Counseling Pllc Samantha Wagner Sole Mbr 112 N 2nd St Rockford IL 61107-4051 Ph: (608) 313-4655 |
| NPI Number | 1407655509 |
|---|---|
| Provider Enumeration Date | 03/11/2025 |
| Last Update Date | 03/11/2025 |
| Certification Date | 03/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407655509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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