JEROME P WAGNER Clinical Psychologist License verification

Business Entity

ACTIVE

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071002913

License Status

ACTIVE

Business

First Name

JEROME

Middle

Last Name

WAGNER

Business Name

JEROME P WAGNER

Original Issue Date

06/03/1982

Effective Date

07/09/2024

Expiration Date

09/30/2026

City

EVANSTON

State

Zip

60201

Ever Disciplined

LastModifiedDate

07/09/2024