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1720583842
BRADLEY JAY WAGNER
MISSOULA, MT
NPI
1720583842
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT 29887)
Enumeration Date
2018-03-29
Last Update Date
2018-03-29
Business Address
Mr. BRADLEY JAY WAGNER LAC
1321 WYOMING ST
MISSOULA, MT 59801-1725
Phone number: 406-532-9901
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Mailing Address
Mr. BRADLEY JAY WAGNER LAC
140 N RUSSELL ST
MISSOULA, MT 59801-1704
Phone number: 406-532-9900
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