JEROME PETER WAGNER

EVANSTON, IL
NPI1487664850
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy103TC0700X Psychologist, Clinical
(Licence: IL  071-002913)
Enumeration Date2006-08-09
Last Update Date2007-07-08
Business Address
Dr. JEROME PETER WAGNER Ph.D.
2603 BROADWAY AVE
EVANSTON, IL 60201-1501
Phone number: 847-492-1690
Mailing Address
Dr. JEROME PETER WAGNER Ph.D.
2603 BROADWAY AVE
EVANSTON, IL 60201-1501
Phone number:
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