| Wagener Therapy Plc | |
|
6119 Deere Creek Ln Davenport IA 52807-3402 | |
| (224) 216-4209 | |
| Not Available |
| Full Name | Wagener Therapy Plc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 6119 Deere Creek Ln, Davenport, Iowa |
| Authorized Official Name and Position | Brandal J Wagener (OWNER) |
| Authorized Official Contact | 2242164209 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagener Therapy Plc 4620 E 53rd St Davenport IA 52807-3620 Ph: (224) 216-4209 | Wagener Therapy Plc 6119 Deere Creek Ln Davenport IA 52807-3402 Ph: (224) 216-4209 |
| NPI Number | 1750048898 |
|---|---|
| Provider Enumeration Date | 11/23/2021 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750048898 | NPI | - | NPPES |
| 1760038475 | Other | IA | WELLMARK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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