Virginia Yvonne Wagner

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.006812 Issued in IL

Practice address

400 N Pleasant Ave
Centralia, IL 62801-3056

Phone

(618) 437-8692

Fax

(618) 436-6420

NPI assigned

Feb 23, 2018

Last updated

Feb 23, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519344000000",
    "number": "1225539398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 W 4TH ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015718",
            "telephone_number": "618-532-3558",
            "fax_number": "618-436-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013056",
            "telephone_number": "618-437-8692",
            "fax_number": "618-436-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "VIRGINIA",
        "middle_name": "YVONNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-23",
        "last_updated": "2018-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.006812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christin Lynn Wall, RN
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• Clinical Social Worker in Centralia, IL
• Providers in Centralia, 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 Feb 23, 2018; 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.