Healthcare Provider Details

I. General information

NPI: 1780331603
Provider Name (Legal Business Name): HALI R WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD STE C209
BLUE ASH OH
45242-6875
US

IV. Provider business mailing address

9403 KENWOOD RD STE C209
BLUE ASH OH
45242-6875
US

V. Phone/Fax

Practice location:
  • Phone: 513-655-6911
  • Fax:
Mailing address:
  • Phone: 513-655-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.2607363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: