Provider Demographics
NPI:1801265624
Name:WAGNER, ASHLEY NICOLE MCCANN (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY NICOLE
Middle Name:MCCANN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 NE 116TH ST # 7496
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4245
Mailing Address - Country:US
Mailing Address - Phone:254-448-0132
Mailing Address - Fax:
Practice Address - Street 1:19729 170TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7059
Practice Address - Country:US
Practice Address - Phone:254-448-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60691352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health