Amy Wagner, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178007525 Issued in IL

Practice address

2272 95TH St
Unit 305
Naperville, IL 60564-8942

Phone

(630) 753-9800

NPI assigned

Aug 12, 2016

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

Enrolled in IL

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

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Modify PCGroup PAC ID 8628355963, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Modify, P.C.

  • Clinical Psychologist
  • Naperville, IL
  • NPI 1457479503
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1801340393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2272 95TH ST",
            "address_2": "UNIT 305",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648942",
            "telephone_number": "630-753-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2272 95TH ST",
            "address_2": "UNIT 305",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648942",
            "telephone_number": "630-753-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "AMY",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-12",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178007525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Vyskocil
• Barbora Vystejnova, DPT
• Aili Wachtel, LCPC
• Lara Waechtler
• Sindhu Wagle Reshmi Thapa, DDS
• Dana Beth Wagner, PSYD
• Jennifer Lynn Wagner, LCPC, CADC
• Kurt Arthur Wagner, DDS
• Lisa M Wagner, LPC
• Michael Wagner, MD

• Mental Health Counselor in Naperville, IL
• Providers in Naperville, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.