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General NPI Number Information
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NPI Number | 1417147984
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Entity Type | Individual
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Provider Name | KATHLEEN J. WAGNER LCSW, LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 3021 6TH AVENUE NORTH SUITE 106
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City | BILLINGS
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State | MT
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Zip | 59101-2223
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Country | US
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Telephone | 406-245-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 AVENUE D STE 2A
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City | BILLINGS
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State | MT
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Zip | 59102-3015
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Country | US
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Telephone | 406-245-1338
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 42
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License Number State | MT
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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 | 785
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License Number State | MT
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