Kelly Jean Wagner, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

00850 Issued in IA

Practice address

4301 Sergeant Rd
Ste 203
Sioux City, IA 51106-4710

Phone

(712) 276-9000

Fax

(712) 276-4917

NPI assigned

Aug 10, 2009

Last updated

Aug 10, 2009By the provider in NPPES

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

Other names 1

• Kelly Jean O'Connell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lutheran Family Service

  • Voluntary or Charitable Agency
  • Fort Dodge, IA
  • NPI 1316059496
  NPD (past)

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

{
    "created_epoch": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249862400000",
    "number": "1750513727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 9TH AVE N",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505012411",
            "telephone_number": "515-573-3138",
            "fax_number": "515-573-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 SERGEANT RD",
            "address_2": "STE 203",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064710",
            "telephone_number": "712-276-9000",
            "fax_number": "712-276-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-10",
        "last_updated": "2009-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "00850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "O'CONNELL",
            "middle_name": "JEAN",
            "credential": "LMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wagner Chiropractic
• Wagner Chiropractic P.C.
• David V Wagner, MD
• Hailey Wagner
• Jason Leigh Wagner, L.M.H.C.
• Wagner, Kuntz & Grabouski
• Richard W Wagner Jr., DDS MS
• Wallace J Wagner
• Wal-Mart Stores, Inc. (Vision Center 30-1361)
• Wal-Mart Stores, Inc. (Vision Center 30-3590)

• Mental Health Counselor in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; 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.