BRADLEY JAY WAGNER

MISSOULA, MT
NPI1720583842
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT  29887)
Enumeration Date2018-03-29
Last Update Date2018-03-29
Business Address
Mr. BRADLEY JAY WAGNER LAC
1321 WYOMING ST
MISSOULA, MT 59801-1725
Phone number: 406-532-9901
Mailing Address
Mr. BRADLEY JAY WAGNER LAC
140 N RUSSELL ST
MISSOULA, MT 59801-1704
Phone number: 406-532-9900
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