MEDICARE: BETTY LOUISE WAGNER LCSW

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	1041C0700X	Clinical Social Worker	L7525	OR
2	104100000X	Social Worker	6801081590	MI

General Provider Information

NPI Number	:	1720132129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY LOUISE WAGNER LCSW

Provider Business Mailing Address
First Line	:	1028 BIRMLEY ESTATES DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8838
Country	:	US
Telephone Number	:	231-492-6529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 BIRMLEY ESTATES DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8838
Country	:	US
Telephone Number	:	231-492-6529
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/12/2026

Similar Medicare Providers

1730201773 — MR. JAMIEL SHARIEF HAFIZ LPA, LAC
Practice Location Address:

8838 COURT AVE , SUITE 101
ELLICOTT CITY, MD
21043-4614

Practice Phone: 410-227-4939
Practice Fax: 877-735-6141

1912839929 — NATALIE CLARE ANDERSON
Practice Location Address:

1363 DOUGLAS DR STE 104
TRAVERSE CITY, MI
49696-8980

Practice Phone: 231-272-2472
Practice Fax:

1942295274 — KARRI ELIZABETH VAUGHAN PA-C
Practice Location Address:

4624 N SPIDER LAKE RD
TRAVERSE CITY, MI
49696-8440

Practice Phone: 231-947-0673
Practice Fax:

1295755122 — NORTHWEST SENIOR RESOURCES INCORPORATED
Practice Location Address:

1609 PARK DR
TRAVERSE CITY, MI
49696-5946

Practice Phone: 231-947-8920
Practice Fax: 231-947-6401

1417033853 — AIRWAY OXYGEN INC
Practice Location Address:

1396 TRADE CENTRE DR , UNIT B
TRAVERSE CITY, MI
49696

Practice Phone: 231-932-0399
Practice Fax: 231-932-0453

1609098300 — TARA J RYBICKI R.D.
Practice Location Address:

71 WOODED VALLEY DR
TRAVERSE CITY, MI
49696-8740

Practice Phone: 231-620-5533
Practice Fax:

Directions to “ BETTY LOUISE WAGNER LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.