Healthcare Provider Details

I. General information

NPI: 1114484714
Provider Name (Legal Business Name): TERESA WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 ROSEBUD LN
BILLINGS MT
59101-6527
US

IV. Provider business mailing address

1341 ROSEBUD LN
BILLINGS MT
59101-6527
US

V. Phone/Fax

Practice location:
  • Phone: 406-534-1755
  • Fax:
Mailing address:
  • Phone: 406-534-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number31530
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: