| NPI | 1568954188 |
|---|---|
| Former Name | JORDAN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5953) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: OR ART-C-10209317) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2025-04-21 |