Provider Demographics
NPI:1922435668
Name:WAGNER, SARAH J (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:127 S MCKEAN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-6029
Mailing Address - Country:US
Mailing Address - Phone:724-991-1289
Mailing Address - Fax:724-498-0527
Practice Address - Street 1:371 NORTH MAIN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-991-1289
Practice Address - Fax:724-241-3568
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional