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1760038475
BRANDAL J WAGENER
DAVENPORT, IA
NPI
1760038475
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: IA 093843)
Enumeration Date
2019-08-18
Last Update Date
2023-02-26
Business Address
MR. BRANDAL J WAGENER LMHC
4620 E 53RD ST STE 200
DAVENPORT, IA 52807-3627
Phone number: 224-216-4209
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Mailing Address
MR. BRANDAL J WAGENER LMHC
4620 E 53RD ST STE 200
DAVENPORT, IA 52807-3627
Phone number: 224-216-4209
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