Glavis M Wagner

NPI #1720587553 in Pendleton, Oregon

Provider Information

NPI Number: 1720587553
Entity Type: Individual
Name: Glavis M Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Prevention Professional
Enumeration Date: Feb 7, 2018
Last Updated: Jul 23, 2020

Practice Location

Address: 46314 TIMINE WAY
City: Pendleton
State: Oregon
ZIP Code: 97801
Phone: (541) 966-9830

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Peer Specialist	175T00000X
Prevention Professional	405300000X	Primary

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