Most Relevant Information
Provider Data
| NPI Number: | 1003480922 |
| Provider Name: | SAMANTHA WAGNER LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 178016407 |
Most Important Dates
| Enumeration Date: | 05/15/2021 |
| Last Updated: | 05/15/2021 |
Provider Practice Location
63 BRITTANY DR
OAKWOOD HILLS
IL
600136080
Practice Location Phone/Fax
| Phone: | 6302731524 |
| Fax: |
Provider Mailing Location
63 BRITTANY DR
OAKWOOD HILLS
IL
600136080
Provider Mailing Phone/Fax
| Phone: | 6302731524 |
| Fax: |