Provider Demographics
NPI:1013257302
Name:KATHLEEN J WAGNER LCSW
Entity Type:Organization
Organization Name:KATHLEEN J WAGNER LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-245-1338
Mailing Address - Street 1:PO BOX 2252
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-2252
Mailing Address - Country:US
Mailing Address - Phone:406-245-1338
Mailing Address - Fax:406-294-5226
Practice Address - Street 1:820 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2049
Practice Address - Country:US
Practice Address - Phone:406-245-1338
Practice Address - Fax:406-294-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty