Shannon Wagoner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007200A Issued in IN

Practice address

697 Pro Med LN
Carmel, IN 46032-5323

Phone

(317) 574-1254

Fax

(317) 674-0060

NPI assigned

Nov 22, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1760191399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9615 E 148TH ST STE 1",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460604371",
            "telephone_number": "317-574-1254",
            "fax_number": "317-674-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "697 PRO MED LN",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325323",
            "telephone_number": "317-574-1254",
            "fax_number": "317-674-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "SHANNON",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-22",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007200A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Leigh Wagner
• Beth Wagner
• Debra Lynn Wagner, CPNP
• Katalyn Wagner
• Scott Wagner, PHARM.D.
• Gregory R Wahle, M.D.
• Stephanie Wainscott
• Jonathon Wake
• David Rollin Wakeland, MD
• Wal-Mart Stores East LP

• Clinical Social Worker in Carmel, IN
• Providers in Carmel, 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, 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.