Healthcare Provider Details

I. General information

NPI: 1588522635
Provider Name (Legal Business Name): JOSEPH EUGENE WAGNER SWLC, DTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N WASHINGTON ST APT 8
HELENA MT
59601-3265
US

IV. Provider business mailing address

830 N WARREN ST
HELENA MT
59601-3404
US

V. Phone/Fax

Practice location:
  • Phone: 775-223-4786
  • Fax:
Mailing address:
  • Phone: 406-315-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-87652
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86170851
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: