Jeanne Wagoner
Specialist in Cleveland Hts, OH. Individual provider (NPI-1).
NPI number1760880314
StatusActive
Last updated in NPPESDec 15, 2014
Details
- NPI
- 1760880314
- Entity type
- Individual (NPI-1)
- Name
- Jeanne Wagoner
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 15, 2014
- Last updated
- Dec 15, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 34778885 | OH | Yes |
Practice location
2400 Roxboro RdCleveland Hts, OH 44106-3624
Phone 216-320-3136
Mailing address
17556 Fairlawn DrChagrin Falls, OH 44023-6419
Phone 216-320-3136
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