Mary Kathleen Wagner, LCSW CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149020151 Issued in IL

Practice address

2451 W Cortland St Apt 3
Chicago, IL 60647-0452

Phone

(847) 334-2755

NPI assigned

Mar 3, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1144815994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 W CORTLAND ST APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606470452",
            "telephone_number": "847-334-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 W CORTLAND ST APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606470452",
            "telephone_number": "847-334-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "LCSW CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-03",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149020151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle J Wagner, DPT
• Lauren E Wagner, M.D.
• Lindsay Wagner, CRNA
• Lisa Wagner
• Lynne I. Wagner, PH.D.
• Maximilian Wagner
• Olivia Wagner, RDN, LDN
• Paula J Wagner, APN
• Regina E Wagner, RPH
• Stephanie Wagner, MD

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.