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1902493240
STEPHANIE NICOLE WAGNER
PORTLAND, OR
NPI
1902493240
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR T-20-431)
Enumeration Date
2020-12-21
Last Update Date
2020-12-21
Business Address
STEPHANIE NICOLE WAGNER
2600 SE BELMONT ST
PORTLAND, OR 97214-2916
Phone number: 503-239-5738
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Mailing Address
STEPHANIE NICOLE WAGNER
2600 SE BELMONT ST
PORTLAND, OR 97214-2916
Phone number: 503-239-5738
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