Provider Information for 1336713080
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NATASHA MARIE WAGNER LPC
Other Names:Former Name:NATASHA MARIE JOHNSON LPCSex: Female
NPI: 1336713080
Last Updated: 2021-05-18
Certification Date: 2021-05-18
Certification Date: 2021-05-18
Details
| Name | Value | ||||||||
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| NPI | 1336713080 | ||||||||
| Enumeration Date | 2021-05-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5909 W AUTUMN VISTA WAY FLORENCE, AZ 85132-1294 United States Phone: 480-540-1099 | Fax: | ||||||||
| Primary Practice Address | 5909 W AUTUMN VISTA WAY FLORENCE, AZ 85132-1294 United States Phone: 480-540-1099 | Fax: | ||||||||
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