Kenyada Marie Wagoner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

114731 Issued in CA

Practice address

4361 Latham St Ste 220
Riverside, CA 92501-1767

Phone

(858) 279-1223

NPI assigned

May 12, 2023

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kenyada.wagoner.p1@direct.chsica.nextgenshare.com

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.

• Healing Haven Mental Health

  • Clinical Social Worker
  • San Jacinto, CA
  • NPI 1922975978
  Medicare reassignment NPD Authorized official
• Clinical Solutions, Licensed Clinical Social Worker, Inc.

  • Clinical Social Worker
  • San Jacinto, CA
  • NPI 1124955737
  NPD Authorized official
• Community Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bloomington, CA
  • NPI 1952308009
  Medicare reassignment NPD (past)
• Healing Haven Licensed Clinical

  • Clinical Social Worker
  • San Jacinto, CA
  • NPI 1144046608
  NPD (past) Authorized official
• Community Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Moreno Valley, CA
  • NPI 1679749501
  NPD
• Indiana University Health Ball Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Muncie, IN
  • NPI 1225195340
  NPD (past)

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1760172688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E ESPLANADE AVE UNIT 1581",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835102",
            "telephone_number": "951-214-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 LATHAM ST STE 220",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925011767",
            "telephone_number": "858-279-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Commercenter E Ste 210",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924083424",
            "country_code": "US",
            "telephone_number": "909-567-2575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "KENYADA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-12",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "114731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Haydee Waggoner
• Margaret Waghorn, PTA (ASSOCIATES)
• Brandon M Wagner
• Michelle Kerry Wagner, RD
• Susan Katali Wagner, PA-C
• Hakan Erik Wahlstrom, M.D.
• Alain A Waked, M.D.
• Lauren Angelique Wakoski
• Trisha Waldecker
• Walden Environment

• Clinical Social Worker in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.