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General NPI Number Information
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NPI Number | 1013257302
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Entity Type | Organization
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Legal Business Name | KATHLEEN J WAGNER LCSW
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 820 DIVISION ST
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City | BILLINGS
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State | MT
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Zip | 59101-2049
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Country | US
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Telephone | 406-245-1338
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Fax | 406-294-5226
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Provider Business Mailing Address
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Address Line | PO BOX 2252
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City | BILLINGS
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State | MT
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Zip | 59103-2252
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Country | US
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Telephone | 406-245-1338
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Fax | 406-294-5226
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Authorized Official
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Title or Position | DIRECTOR
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Name | KATHLEEN WAGNER
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Credential | LCSW
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Telephone | 406-245-1338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 785
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License Number State | MT
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