Active NPI
Emmarie Truman Wagner, LMSW
- Clinical Social Worker
- Ann Arbor, MI
National Provider Identifier
1114511458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801116797
- Practice address
- 343 S Main St Ste 211
Ann Arbor, MI 48104-2138 - Phone
- (734) 412-7400
- NPI assigned
- Feb 26, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801109040 | MI | |
| Clinical Social Worker | 1041C0700X | 6801116797 | MI | Primary |
Addresses
Primary practice location
343 S Main St Ste 211
Ann Arbor, MI 48104-2138
Mailing address
343 S Main St Ste 211
Ann Arbor, MI 48104-2138
Phone (734) 412-7400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 23, 2024 through Feb 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801109040 | MI | MD | Clinical Social Worker |
| 6801116797 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1114511458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "343 S MAIN ST STE 211",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042138",
"telephone_number": "734-412-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "343 S MAIN ST STE 211",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042138",
"telephone_number": "734-412-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "EMMARIE",
"middle_name": "TRUMAN",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-26",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801109040",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801116797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.