Active NPI
Jennifer Wagner, LCSW
- Clinical Social Worker
- Austin, TX
National Provider Identifier
1578843694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 37961
- Practice address
- 418 Grace LN
Austin, TX 78746-4813 - Phone
- (512) 551-1794
- NPI assigned
- Aug 19, 2011
- 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 | 37961 | TX | Primary |
Addresses
Primary practice location
418 Grace LN
Austin, TX 78746-4813
Mailing address
11115 Appletree LN
Austin, TX 78726-1381
Phone (512) 551-1794
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37961 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475884800000",
"number": "1578843694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11115 APPLETREE LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787261381",
"telephone_number": "512-551-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 GRACE LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787464813",
"telephone_number": "512-551-1794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JENNIFER",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-19",
"last_updated": "2016-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "37961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.