Jennifer Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149015113 Issued in IL

Practice address

800 S Milwaukee Ave Ste 105
Libertyville, IL 60048-3268

Phone

(847) 816-9180

Fax

(847) 816-9183

NPI assigned

Jan 8, 2016

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 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

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amaryllis Counseling Services PLLC

  • Clinical Social Worker
  • Libertyville, IL
  • NPI 1184428922
  Medicare reassignment NPD Authorized official
• Rockland Professional Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Libertyville, IL
  • NPI 1295897148
  NPD (past)
• The Tree House Center for Growth and Learning

  • Clinical Psychologist
  • Arlington Heights, IL
  • NPI 1528460235
  NPD (past)

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1881050607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26194 N HICKORY AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604006",
            "telephone_number": "224-627-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S MILWAUKEE AVE STE 105",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483268",
            "telephone_number": "847-816-9180",
            "fax_number": "847-816-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JENNIFER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149015113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Vrenios
• Kaitlyn Nicole Vu, DPM
• Tosha Vyas
• A Yaser Wafai, MD
• Christina Wagner, M.S., LCPC
• Jacylyn Denise Wahl, MPAS, PA-C
• Waldemar Mysiak MD SC (Family Health Center)
• Walgreen Co (Walgreens #05258)
• Walgreen Co (Walgreens #05257)
• Ann Walsh

• Clinical Social Worker in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.