Kristen G Wagoner

NPI #1982057337 in Chesterton, Indiana

Provider Information

NPI Number: 1982057337
Entity Type: Individual
Name: Kristen G Wagoner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Developmental Therapist
Enumeration Date: Jul 21, 2016
Last Updated: Jul 21, 2016

Practice Location

Address: 1595 S CALUMET RD
Address 2: SUITE #3
City: Chesterton
State: Indiana
ZIP Code: 46304-2388
Phone: (219) 763-6858

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Developmental Therapist	222Q00000X	Primary

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