Samantha Wagner

NPI #1124524608 in Rockford, Illinois

Provider Information

NPI Number: 1124524608
Entity Type: Individual
Name: Samantha Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Enumeration Date: Apr 3, 2018
Last Updated: Apr 3, 2018

Practice Location

Address: 8616 NORTHERN AVE
City: Rockford
State: Illinois
ZIP Code: 61107-5309
Phone: (815) 332-8003

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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