Provider Demographics
NPI:1255478574
Name:LAGER, KARIN (MS LMFT SAC)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:
Last Name:LAGER
Suffix:
Gender:F
Credentials:MS LMFT SAC
Other - Prefix:MISS
Other - First Name:KARIN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LMFT CADC
Mailing Address - Street 1:1810 APPLETON ROAD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1110
Mailing Address - Country:US
Mailing Address - Phone:920-739-4226
Mailing Address - Fax:920-739-7639
Practice Address - Street 1:1810 APPLETON ROAD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952
Practice Address - Country:US
Practice Address - Phone:920-739-4226
Practice Address - Fax:920-739-7639
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI593124106H00000X
WI11646131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43581800Medicaid