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General NPI Number Information
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NPI Number | 1265537484
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Entity Type | Individual
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Provider Name | IAN JEFFREY AGAR MSW, LCSW, CADC III
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | WAUSAU VETERANS OUTPATIENT CLINIC 515 S. 32ND AVENUE
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City | WAUSAU
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State | WI
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Zip | 54401
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Country | US
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Telephone | 715-842-2834
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Fax | 715-845-8211
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Provider Business Mailing Address
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Address Line | W15354 COUNTY HIGHWAY D
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City | WITTTENBERG
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State | WI
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Zip | 54499
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Country | US
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Telephone | 715-793-4411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13523
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7098-123
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License Number State | WI
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