Active NPI
Kimberly Wagner, PH.D.
- Counseling Psychologist
- Bloomington, IN
National Provider Identifier
1245352855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 20042059A
- Practice address
- 201 N Rose Ave
Room 32
Bloomington, IN 47405-1005 - Phone
- (812) 856-8572
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 20042059A | IN | Primary |
Addresses
Primary practice location
201 N Rose Ave
Room 32
Bloomington, IN 47405-1005
Mailing address
2401 E 8TH St
Bloomington, IN 47408-4212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20042059A | IN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245352855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 E 8TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474084212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 N ROSE AVE",
"address_2": "ROOM 32",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474051005",
"telephone_number": "812-856-8572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KIMBERLY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "IN",
"license": "20042059A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- 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.