Provider Demographics
NPI:1679170591
Name:WAGNER, RACHEL LOUISE (MSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LOUISE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W RIVERSIDE AVE STE 614
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0402
Mailing Address - Country:US
Mailing Address - Phone:509-413-6875
Mailing Address - Fax:509-381-3538
Practice Address - Street 1:421 W RIVERSIDE AVE STE 614
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0402
Practice Address - Country:US
Practice Address - Phone:509-413-6875
Practice Address - Fax:509-381-3538
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611000451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical