Brandal J Wagener, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

093843 Issued in IA

Practice address

4620 E 53Rd St Ste 200
Davenport, IA 52807-3627

Phone

(224) 216-4209

NPI assigned

Aug 18, 2019

Sex

Male

Sole proprietor

No

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

Practice roles

Locations

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.

• Wagener Therapy PLC

  • Mental Health Counselor
  • Davenport, IA
  • NPI 1750048898
  NPD Authorized official

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

{
    "created_epoch": "1566086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677369600000",
    "number": "1760038475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 E 53RD ST STE 200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073627",
            "telephone_number": "224-216-4209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 E 53RD ST STE 200",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073627",
            "telephone_number": "224-216-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENER",
        "first_name": "BRANDAL",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-18",
        "last_updated": "2023-02-26",
        "certification_date": "2023-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "093843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Olin Meloy Voelliger, LMSW
• Ilya B Volfson, MD
• John J. (Io) Von Arb, D.D.S.
• Elizabeth Vondera
• Wagener Therapy PLC
• Sarah Wagener, T-LMHC
• Denise Jean Wagner, PHARMD
• Lisa Wagner
• Rebecca Wagschal, ARNP, CNM
• Craig Stephen Wainwright, ATC-LAT

• Mental Health Counselor in Davenport, IA
• Providers in Davenport, 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 Feb 26, 2023; 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.