Carolyn Wagner
Clinic/Center, Mental Health (Including Community Mental Health Center) in Wilmette, IL. Organization (NPI-2).
NPI number1164047072
StatusActive
Last updated in NPPESJun 16, 2020
Details
- NPI
- 1164047072
- Entity type
- Organization (NPI-2)
- Legal business name
- Carolyn Wagner
- Organization subpart
- No
- Enumeration date
- Jun 16, 2020
- Certification date
- Jun 16, 2020
- Last updated
- Jun 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
1159 Wilmette Ave Ste 225Wilmette, IL 60091-2653
Phone 847-728-8148
Mailing address
1159 Wilmette Ave Ste 225Wilmette, IL 60091-2653
Phone 847-728-8148
Authorized official
Carolyn Wagner
Psychotherapist
8477288148
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