| NPI | 1538769831 |
|---|---|
| Former Name | JAUTON WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW96292) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW96292) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2021-03-23 |