Active NPI
Allen Wagner, MS
- Professional Counselor
- La Crosse, WI
National Provider Identifier
1952468936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 869-125
- Practice address
- 421 22ND St S
La Crosse, WI 54601-5046 - Phone
- (608) 782-4575
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 869-125 | WI | Primary |
| Clinical Social Worker | 1041C0700X | 3214 | WI |
Addresses
Primary practice location
421 22ND St S
La Crosse, WI 54601-5046
Mailing address
421 22ND St S
La Crosse, WI 54601-5046
Phone (608) 782-4575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 869-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262563200000",
"number": "1952468936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 22ND ST S",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546015046",
"telephone_number": "608-782-4575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 22ND ST S",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546015046",
"telephone_number": "608-782-4575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ALLEN",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2010-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "869-125",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "3214",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.