Active NPI
Lida Wagner, LCSW
- Clinical Social Worker
- Niles, IL
National Provider Identifier
1386947737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149014271
- Practice address
- 999 Civic Center Dr
Niles, IL 60714-3224 - Phone
- (847) 588-8460
- NPI assigned
- Dec 7, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149014271 | IL | Primary |
Addresses
Primary practice location
999 Civic Center Dr
Niles, IL 60714-3224
Mailing address
999 Civic Center Dr
Niles, IL 60714-3224
Phone (847) 588-8460
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291680000000",
"number": "1386947737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "999 CIVIC CENTER DR",
"city": "NILES",
"state": "IL",
"postal_code": "607143224",
"telephone_number": "847-588-8460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 CIVIC CENTER DR",
"city": "NILES",
"state": "IL",
"postal_code": "607143224",
"telephone_number": "847-588-8460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LIDA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-07",
"last_updated": "2010-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149014271",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.