Doctor Name: | DR. JEANNE K WAGENFELD |
NPI Number: | 1316973092 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LP LPC |
License Number: | 6401004476 |
Business Practice Address: | 304 W Michigan Ave Paw Paw, MI - 49079 |
Business Phone Number: | 2696575800 |
Business Fax Number: | 2696578939 |
Mailing Address: | 304 W Michigan Ave, PAW PAW |
State: | MI |
Postal Code: | 49079 |
Phone Number: | 2696575800 |
Fax Number: | 2696578939 |
NPI Enumeration Date: | 06/24/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 6401004476 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |