Provider Demographics
NPI:1942541776
Name:WAGNER, JO FRANCES (MS)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:FRANCES
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1819
Mailing Address - Country:US
Mailing Address - Phone:509-710-9792
Mailing Address - Fax:509-287-2345
Practice Address - Street 1:120 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1819
Practice Address - Country:US
Practice Address - Phone:509-710-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60286803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health