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NPI Code Detail

MEDICARE: JEFFREY WAGNER

MEDICARE: JEFFREY WAGNER
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
11041C0700XClinical Social WorkerLW70042194WA

General Provider Information

NPI Number : 1396424842
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY WAGNER
Provider Business Mailing Address
First Line : 100 N HOWARD ST STE W
Second Line :
City : SPOKANE
State : WA
Zip : 99201-0508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 123 NW 36TH ST STE 210
Second Line :
City : SEATTLE
State : WA
Zip : 98107-4959
Country : US
Telephone Number : 425-640-7009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2023
Last Update Date : 12/08/2025

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Directions to “ JEFFREY WAGNER ” Practice Location

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