MEDICARE: VELMA WAGNER-ADAMS

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
1	103TC1900X	Counseling Psychologist	LP0320	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103058	OTHER	MN	UCARE
2	1G213WA	OTHER	MN	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1235128331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VELMA WAGNER-ADAMS

Provider Business Mailing Address
First Line	:	4048 PLEASANT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1545
Country	:	US
Telephone Number	:	612-824-4719
Fax Number	:	612-822-1850

Provider Business Practice Location Address
First Line	:	4100 HARRIET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1443
Country	:	US
Telephone Number	:	612-877-1436
Fax Number	:	612-822-1850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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Directions to “ VELMA WAGNER-ADAMS ” Practice Location

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