Tara Jo Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007711A Issued in IN

Practice address

5905 Berry LN
Evansville, IN 47710-4377

Phone

(812) 205-3787

NPI assigned

Mar 12, 2010

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: tarawagner@tdh.allscriptsdirect.net

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.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD
• Advanced Rehabilitation,Inc.

  • Rehabilitation Clinic/Center
  • Tell City, IN
  • NPI 1154319101
  NPD (past)

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1598088973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5905 BERRY LN",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477104377",
            "telephone_number": "812-205-3787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 BERRY LN",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477104377",
            "telephone_number": "812-205-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TARA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-12",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007711A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Andrew Wager, DPT
• Zachary Waggoner
• Mary Wagner
• Richard Alan Wagner, M.D.
• Sarah L Wagner, PA
• Gary Wagoner, BS
• Christen Wahl, APRN
• Daniel Ronald Wahl
• Kasey E Wahl, ATC
• David T Wahle, M.D.

• Clinical Social Worker in Evansville, IN
• Providers in Evansville, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.