Susan D. Wagner, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC33511 Issued in CA

Practice address

1549 Pacific Ave
Santa Rosa, CA 95404-3507

Phone

(707) 545-7706

Fax

(707) 887-2035

NPI assigned

Oct 19, 2008

Last updated

Oct 19, 2008By the provider in NPPES

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1224374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224374400000",
    "number": "1629220801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1549 PACIFIC AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043507",
            "telephone_number": "707-545-7706",
            "fax_number": "707-887-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1549 PACIFIC AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043507",
            "telephone_number": "707-545-7706",
            "fax_number": "707-887-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SUSAN",
        "middle_name": "D.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-19",
        "last_updated": "2008-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC33511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Stephen Wagner, MD
• Eric Wagner
• Irven Robert Wagner, O.D.
• Jennifer Wagner
• Richard C Wagner
• Madeleine Waldmann, MFT
• Walgreen Co (Walgreens #03297)
• Walgreen Co (Walgreens #06722)
• Kimberly Anne Walker - Demattei, LMFT
• Keamiyah Neishelle Walker, MSN, APRN,FNP-C

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2008; 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.