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NPI Code Detail

MEDICARE: LAUREN WAGNER LSW

MEDICARE:   LAUREN  WAGNER  LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149-024460IL

General Provider Information

NPI Number : 1831862747
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN WAGNER LSW
Provider Business Mailing Address
First Line : 11824 SOUTHWEST HWY STE 230
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1085
Country : US
Telephone Number : 630-469-9200
Fax Number :
Provider Business Practice Location Address
First Line : 11824 SOUTHWEST HWY STE 230
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1085
Country : US
Telephone Number : 847-493-3650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2021
Last Update Date : 04/06/2026

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Directions to “ LAUREN WAGNER LSW” Practice Location

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