Provider Demographics
NPI:1114511458
Name:WAGNER, EMMARIE TRUMAN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:EMMARIE
Middle Name:TRUMAN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2138
Mailing Address - Country:US
Mailing Address - Phone:734-412-7400
Mailing Address - Fax:
Practice Address - Street 1:343 S MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2138
Practice Address - Country:US
Practice Address - Phone:734-412-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011090401041C0700X
MI68011167971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical