Richard J Vanwagoner, LBSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802020984 Issued in MI

Practice address

216 W Morrell St Ste 300
Jackson, MI 49203-2351

Phone

(517) 782-0380

Fax

(517) 782-6275

NPI assigned

Sep 27, 2016

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

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.

• Community Normalization Homes Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Jackson, MI
  • NPI 1245329754
  NPD (past)

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1790234151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3366 REYNOLDS RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492019398",
            "telephone_number": "517-240-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 W MORRELL ST STE 300",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492032351",
            "telephone_number": "517-782-0380",
            "fax_number": "517-782-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWAGONER",
        "first_name": "RICHARD",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LBSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802020984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Scott Vanschoick, M.D.
• Beth Sue Vansumeren
• Aaron Michael Vanwagnen, MD
• Lenae E Vanwagnen, M.D.
• Lynn Clark Vanwagnen, MD
• Tracy Dawn Vanwoert, MASSAGE THERAPIST
• Jonathon Walter Vargo, MD
• Amy Jean Varner, OTR/L
• Unknown Varsha, M.D.
• Jelena Vasiljevic

• Social Worker in Jackson, MI
• Providers in Jackson, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.