| Carolyn Wagner | |
|
1159 Wilmette Ave Ste 225 Wilmette IL 60091-2653 | |
| (847) 728-8148 | |
| Not Available |
| Full Name | Carolyn Wagner |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1159 Wilmette Ave Ste 225, Wilmette, Illinois |
| Authorized Official Name and Position | Carolyn Wagner (PSYCHOTHERAPIST) |
| Authorized Official Contact | 8477288148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn Wagner 1159 Wilmette Ave Ste 225 Wilmette IL 60091-2653 Ph: (847) 728-8148 | Carolyn Wagner 1159 Wilmette Ave Ste 225 Wilmette IL 60091-2653 Ph: (847) 728-8148 |
| NPI Number | 1164047072 |
|---|---|
| Provider Enumeration Date | 06/16/2020 |
| Last Update Date | 06/16/2020 |
| Certification Date | 06/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164047072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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