Corilyn Ashley Wagner

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5588 Issued in MN

Practice address

1129 Grand Ave
Saint Paul, MN 55105-2629

Phone

(612) 619-7611

Fax

(651) 964-4748

NPI assigned

May 14, 2026

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Not enrolled

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.

• Familymeans

  • Mental Health Counselor
  • Stillwater, MN
  • NPI 1881690899
  NPD (past)
• Invigorate Life Counseling, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Paul, MN
  • NPI 1508107541
  NPD (past)

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

{
    "created_epoch": "1778716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1831028174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052629",
            "telephone_number": "651-641-0177",
            "fax_number": "651-641-8635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052629",
            "telephone_number": "612-619-7611",
            "fax_number": "651-964-4748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1205 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551052634",
            "country_code": "US",
            "telephone_number": "612-619-7611",
            "fax_number": "651-964-4748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CORILYN",
        "middle_name": "ASHLEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-05-14",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "5588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Marie Wade, RN, BSN, BA
• Rodnetria Wade
• Shakaris Wade
• Laura Wadzinski, RN
• Kendra Lynn Wagener, LICSW
• Cynthia L Wagner, OTR/L
• Emily Ashley Wagner, MD
• Gerhardt Stefan Wagner, MD
• James Wagner, LMFT
• Jonathan Eric Wagner, LPCC

• Professional Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.