| NPI | 1003916743 |
|---|---|
| Former Name | JENNIFER WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA cw015586) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW013316L) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2012-03-29 |