Provider Demographics
NPI:1245771427
Name:WAGLER, MELODY J (LSCSW)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:WAGLER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LORRAINE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5670
Mailing Address - Country:US
Mailing Address - Phone:620-663-7595
Mailing Address - Fax:620-663-5263
Practice Address - Street 1:1600 N LORRAINE ST
Practice Address - Street 2:STE 202
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5670
Practice Address - Country:US
Practice Address - Phone:620-663-7595
Practice Address - Fax:620-663-5263
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS053181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical