Provider Demographics
NPI:1265537484
Name:AGAR, IAN JEFFREY (MSW, LCSW, CADC III)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:JEFFREY
Last Name:AGAR
Suffix:
Gender:M
Credentials:MSW, LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W15354 COUNTY HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:WITTTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499
Mailing Address - Country:US
Mailing Address - Phone:715-793-4411
Mailing Address - Fax:
Practice Address - Street 1:WAUSAU VETERANS OUTPATIENT CLINIC
Practice Address - Street 2:515 S. 32ND AVENUE
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-842-2834
Practice Address - Fax:715-845-8211
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13523101YA0400X
WI7098-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)