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Jillicia Leeann Wagner
Peer Specialist in Port Huron, Michigan
NPI 1629839022

Jillicia Leeann Wagner is a Peer Specialist based in Port Huron, MI. Jillicia Leeann Wagner practices in Port Huron, MI. The NPI Number for Jillicia Leeann Wagner is 1629839022 and holds a License No. (Michigan).

The current practice location address for Jillicia Leeann Wagner is 3111 Electric Ave, Port Huron, MI and can be reached out via phone at 810-985-8900.

Location: 3111 Electric Ave, Port Huron, MI, 48060-8127
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629839022
Provider Name
Jillicia Leeann Wagner
Credential
Provider Entity Type
Individual
Gender
Female
Address
3111 Electric Ave, Port Huron, MI, 48060-8127
Phone Number
810-985-8900
Fax Number
Provider Enumeration Date
01/22/2024
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3111 Electric Ave
City
Port Huron
State
Michigan
Zip
48060-8127
Phone Number
810-985-8900
Fax Number
person
Provider Business Mailing Address Details
Address
3111 Electric Ave
City
Port Huron
State
Michigan
Zip
48060-8127
Phone Number
810-985-8900
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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