Provider Demographics
NPI:1225164742
Name:WAGNER, KAREN SCHIESS (PH D)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SCHIESS
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:SCHIESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:1212 NE OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086
Mailing Address - Country:US
Mailing Address - Phone:816-525-6619
Mailing Address - Fax:816-554-0055
Practice Address - Street 1:600 SW JEFFERSON ST #206
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063
Practice Address - Country:US
Practice Address - Phone:816-554-7705
Practice Address - Fax:816-554-7706
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
21468020OtherBC BS
0008841Medicare ID - Type Unspecified