Active NPI
Anne Bacon Wagstaff, LPC
- Professional Counselor
- Coeur D Alene, ID
National Provider Identifier
1962572230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-779
- Practice address
- 7905 N Meadowlark Way
Suite C
Coeur D Alene, ID 83815-5041 - Phone
- (208) 762-3979
- Fax
- (208) 762-4419
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-779 | ID | Primary |
Addresses
Primary practice location
7905 N Meadowlark Way
Suite C
Coeur D Alene, ID 83815-5041
Mailing address
7905 N Meadowlark Way
Suite C
Coeur D Alene, ID 83815-5041
Phone (208) 762-3979
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-779 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962572230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7905 N MEADOWLARK WAY",
"address_2": "SUITE C",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838155041",
"telephone_number": "208-762-3979",
"fax_number": "208-762-4419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7905 N MEADOWLARK WAY",
"address_2": "SUITE C",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838155041",
"telephone_number": "208-762-3979",
"fax_number": "208-762-4419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGSTAFF",
"first_name": "ANNE",
"middle_name": "BACON",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.