Provider Demographics
NPI:1730243288
Name:WAGNER, KAREN L (MSW)
Entity type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:L
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 US HIGHWAY 23 N
Mailing Address - Street 2:P.O. BOX 857
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8018
Mailing Address - Country:US
Mailing Address - Phone:989-356-4049
Mailing Address - Fax:989-356-6287
Practice Address - Street 1:1185 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8018
Practice Address - Country:US
Practice Address - Phone:989-356-4049
Practice Address - Fax:989-356-6287
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080389104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker