Healthcare Provider Details

I. General information

NPI: 1629465927
Provider Name (Legal Business Name): BRITNEY WAGLER MSW-LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 9TH ST
JASPER IN
47546-2514
US

IV. Provider business mailing address

800 W 9TH ST
JASPER IN
47546-2514
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-6008
  • Fax: 812-996-0439
Mailing address:
  • Phone: 812-996-6008
  • Fax: 812-996-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008431A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: