JEROME P WAGNER Clinical Psychologist License verification

Business Entity

CANCELLED

License Type

Clinical Psychologist

Description

REGISTERED PSYCHOLOGIST

License Number

072002913

License Status

CANCELLED

Business

First Name

JEROME

Middle

Last Name

WAGNER

Business Name

JEROME P WAGNER

Original Issue Date

06/03/1982

Expiration Date

09/30/1990

City

EVANSTON

State

Zip

60201

County

COOK

Ever Disciplined

LastModifiedDate

09/04/2005