MEDICARE: KIMBERLY WAGNER MSW

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1881098903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WAGNER MSW

Provider Business Mailing Address
First Line	:	2005 S OGDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4134
Country	:	US
Telephone Number	:	920-904-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 N WATER ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2557
Country	:	US
Telephone Number	:	646-453-6777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	01/31/2024

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