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NPI Code Detail

MEDICARE: SARAH M WAGNER M.A., L.M.F.T

MEDICARE: SARAH M WAGNER M.A., L.M.F.T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1973MN

General Provider Information

NPI Number : 1043577497
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH M WAGNER M.A., L.M.F.T
Provider Business Mailing Address
First Line : 8550 HUDSON BLVD N
Second Line :
City : LAKE ELMO
State : MN
Zip : 55042-5500
Country : US
Telephone Number : 651-254-0595
Fax Number :
Provider Business Practice Location Address
First Line : 8550 HUDSON BLVD N
Second Line :
City : LAKE ELMO
State : MN
Zip : 55042-5500
Country : US
Telephone Number : 651-254-0595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 03/02/2021

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