Jamie R Wagner, LCPC, LPC, RPT-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180033993 Issued in IL

Practice address

11447 2ND St
Suite 9B
Roscoe, IL 61073-9522

Phone

(815) 601-4673

Fax

(866) 303-8062

NPI assigned

Jun 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Jamie R Redders Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hope - Child and Family Counseling Inc

  • Mental Health Counselor
  • Roscoe, IL
  • NPI 1942471529
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1073557229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 TANGLEWOOD PL",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535467800",
            "telephone_number": "608-290-6705",
            "fax_number": "866-303-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11447 2ND ST",
            "address_2": "SUITE 9B",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739522",
            "telephone_number": "815-601-4673",
            "fax_number": "866-303-8062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JAMIE",
        "middle_name": "R",
        "credential": "LCPC, LPC, RPT-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "3206-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3206-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180033993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN INSURANCE",
            "identifier": "14270",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCED CLIN. PROF. COUN",
            "identifier": "180033993",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "3206-125",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41000700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "REDDERS",
            "middle_name": "R",
            "credential": "LCPC, LPC, RPT-S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jasmin Weger, RN

• Professional Counselor in Roscoe, IL
• Providers in Roscoe, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.