Active NPI
Logan Douglass Wagner, LSW
- Social Worker
- Marion, IN
National Provider Identifier
1558219378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 99133854A
- Practice address
- 1700 E Bradford Pike
Marion, IN 46952-8643 - Phone
- (765) 664-7740
- NPI assigned
- Mar 18, 2026
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 99133854A | IN | Primary |
Addresses
Primary practice location
1700 E Bradford Pike
Marion, IN 46952-8643
Mailing address
1700 E Bradford Pike
Marion, IN 46952-8643
Phone (765) 664-7740
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99133854A | IN | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paddock View Residential Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Marion, IN
- NPI 1396082863
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1558219378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 E BRADFORD PIKE",
"city": "MARION",
"state": "IN",
"postal_code": "469528643",
"telephone_number": "765-664-7740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 E BRADFORD PIKE",
"city": "MARION",
"state": "IN",
"postal_code": "469528643",
"telephone_number": "765-664-7740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LOGAN",
"middle_name": "DOUGLASS",
"name_prefix": "Mr.",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-18",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "99133854A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.