JEREMY MICHAEL WAGONER

BOWLING GREEN, KY
NPI1982093522
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: KY  3958)
Enumeration Date2015-01-20
Last Update Date2015-01-20
Business Address
-- JEREMY MICHAEL WAGONER LCSW
1300 ANDREA ST SUITE 205
BOWLING GREEN, KY 42104-3382
Phone number: 270-904-2260
Mailing Address
-- JEREMY MICHAEL WAGONER LCSW
1300 ANDREA ST SUITE 205
BOWLING GREEN, KY 42104-3382
Phone number: 270-904-2260
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