Healthcare Provider Details

I. General information

NPI: 1609676774
Provider Name (Legal Business Name): KATIE WAGNER THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 ALGONQUIN RD # 1100
ROLLING MEADOWS IL
60008-4104
US

IV. Provider business mailing address

1551 ALGONQUIN RD # 1100
ROLLING MEADOWS IL
60008-4104
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-9108
  • Fax:
Mailing address:
  • Phone: 773-967-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE WAGNER
Title or Position: OWNER/THERAPIST
Credential:
Phone: 773-967-9108