Provider Demographics
NPI:1457659617
Name:WAGNER-SMITH, SHARON (LISW-S)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WAGNER-SMITH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 MENZOLA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9011
Mailing Address - Country:US
Mailing Address - Phone:614-570-1485
Mailing Address - Fax:
Practice Address - Street 1:3126 MENZOLA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9011
Practice Address - Country:US
Practice Address - Phone:614-570-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00089751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical