person
Jamie R Wagner, LCPC,LPC,RPT-S
Professional Counselor in Roscoe, Illinois
NPI 1073557229

Jamie R Wagner is a Professional Counselor based in Janesville, IL and is specialized in Professional. Jamie R Wagner practices in Roscoe, IL and has the professional credentials of LCPC,LPC,RPT-S. The NPI Number for Jamie R Wagner is 1073557229 and holds a License No. 3206-125 (Illinois).

The current practice location address for Jamie R Wagner is 11447 2Nd St, Roscoe, IL and can be reached out via phone at 815-601-4673 and via fax at 866-303-8062. You can also correspond with Jamie R Wagner through the mailing address at 3705 TANGLEWOOD PL, JANESVILLE, WI - 53546-7800 (mailing address contact number: 608-290-6705).

Location: 11447 2Nd St, Roscoe, IL, 53546-7800
person
Provider Profile Details
NPI Number
1073557229
Provider Name
Jamie R Wagner
Credential
LCPC,LPC,RPT-S
Provider Entity Type
Individual
Gender
Female
Address
11447 2Nd St, Roscoe, IL, 53546-7800
Phone Number
815-601-4673
Fax Number
866-303-8062
Provider Enumeration Date
06/16/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
14270 01 WI DEAN INSURANCE
180033993 01 IL LICENCED CLIN. PROF. COUN
3206-125 01 WI LPC
41000700 05 WI
institution
Provider Business Practice Location Address Details
Address
11447 2Nd St
City
State
Zip
61073-9522
Phone Number
815-601-4673
Fax Number
866-303-8062
person
Provider Business Mailing Address Details
Address
3705 Tanglewood Pl
City
State
Zip
53546-7800
Phone Number
608-290-6705
Fax Number
866-303-8062
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
3206-125 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
3206-125 (Wisconsin)
Definition
Definition to come...
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