Provider Demographics
NPI:1700379609
Name:WACKER, JOSIE ANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:ANNE
Last Name:WACKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:ANNE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 ELMHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7428
Mailing Address - Country:US
Mailing Address - Phone:785-823-6322
Mailing Address - Fax:785-823-3109
Practice Address - Street 1:809 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7428
Practice Address - Country:US
Practice Address - Phone:785-823-6322
Practice Address - Fax:785-823-3109
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201201820AMedicaid