| NPI | 1578023008 |
|---|---|
| Former Name | JENNIFER HALLIE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05915000) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 101945) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-05-15 |