Kari Sue Wagner, M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4340 Issued in CO

Practice address

201 Kendall Drive
Lamar, CO 81052

Phone

(719) 336-7501

Fax

(719) 336-7453

NPI assigned

Feb 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Kari Sue Pederson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073640595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 S 10TH ST",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810524142",
            "telephone_number": "224-366-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 KENDALL DRIVE",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "81052",
            "telephone_number": "719-336-7501",
            "fax_number": "719-336-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KARI",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "4340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCC",
            "identifier": "53344",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARI",
            "last_name": "PEDERSON",
            "middle_name": "SUE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Lamar, CO
• Providers in Lamar, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.