Elizabeth Wagner, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2757 Issued in MN

Practice address

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527

Phone

(952) 993-2498

NPI assigned

Jul 13, 2015

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

Enrolled in MN

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 and National Provider Directory roles.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1467836130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-2498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-2498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 Highway 7 Ste 200",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554263955",
            "country_code": "US",
            "telephone_number": "952-923-0072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELIZABETH",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-13",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Ann Wade, PHD
• Punit D Wadhwa, MD
• Jessica G Wageman, PA-C
• David Bryan Waggonner, M.D.
• Kathy Wagle, APRN, CNS
• Elizabeth Wagner, PSYD
• Gina M Wagner, DPT
• Julie Ann Wagner, NP
• Mary D Wagner
• Sara Ellen Wagner, LICSW

• Marriage & Family Therapist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; 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.