Lisa Wagner, MSE

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7208 Issued in WI

Practice address

1136 Westowne Dr
Neenah, WI 54956-2175

Phone

(920) 456-2030

NPI assigned

Feb 12, 2014

Last updated

Jul 5, 2024By 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 4

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• Children's Service Society of Wisconsin

  • Clinical Social Worker
  • Mount Pleasant, WI
  • NPI 1548434848

  Professional

  NPD (past)

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1407270465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "920-456-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 WESTOWNE DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562175",
            "telephone_number": "920-456-2030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5228 W Fond Du Lac Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53216",
            "country_code": "US",
            "telephone_number": "414-871-9111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5228 W Fond Du Lac Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53216",
            "country_code": "US",
            "telephone_number": "414-871-9111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3900 W Brown Deer Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53209",
            "country_code": "US",
            "telephone_number": "414-540-2170",
            "fax_number": "414-540-2171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8800 Washington Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "534063705",
            "country_code": "US",
            "telephone_number": "262-633-3591",
            "fax_number": "262-633-2619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LISA",
        "credential": "MSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-12",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7208",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7208-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407270465",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100084556",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1136 Westowne Dr",
            "city": "Neenah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549562175",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lwagner371361@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1136 Westowne Dr",
            "city": "Neenah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549562175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Yevgeniy Vvedenskiy, MD
• Emily Elizabeth Wachtendonk, DNP, APRN, FNP-C
• Robert William Wagie, M.M.S., PA-C
• Courtney Wagner
• Jean D. Wagner, RD
• Sara J Wagner, RN
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2986)
• Wal-Mart Stores East, LP (Vision Center 30-2986)
• Megan Waldhart
• Walgreen Co (Walgreens #10236)

• Professional Counselor in Neenah, WI
• Providers in Neenah, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.