| Doctor Name: | MS. SUSAN FOLMAR WAGNER |
| NPI Number: | 1437353976 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | QMHP, MS |
| License Number: | |
| Business Practice Address: | 1040 Allegheny Ave Sw Ocean Crest School Bandon, OR - 974119034 |
| Business Phone Number: | 5413474940 |
| Business Fax Number: | |
| Mailing Address: | 1975 Mcpherson St, Suite 2 NORTH BEND |
| State: | OR |
| Postal Code: | 974593482 |
| Phone Number: | 5413474940 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |