Autumn Wagoner, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2506755 Issued in OH

Practice address

4641 Fulton Dr NW
Canton, OH 44718-2384

Phone

(330) 433-6075

NPI assigned

Nov 9, 2015

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

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 and National Provider Directory roles.

• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763

  OH

  Medicare reassignment NPD
• Child and Adolescent Behavioral Health

  • Addiction (Substance Use Disorder) Counselor
  • Canton, OH
  • NPI 1821577131
  NPD (past)
• Radiology Associates of Canton, Inc.

  • Diagnostic Radiology Physician
  • Canton, OH
  • NPI 1912982034
  NPD (past)

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1962875245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182384",
            "telephone_number": "330-433-6075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182384",
            "telephone_number": "330-433-6075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 S Linden Ave",
            "address_purpose": "LOCATION",
            "city": "Alliance",
            "state": "OH",
            "postal_code": "446013035",
            "country_code": "US",
            "telephone_number": "330-433-6075",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "919 2nd St NE",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447041132",
            "country_code": "US",
            "telephone_number": "330-454-7917",
            "fax_number": "330-454-7917",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1801 SCHNEIDER ST NE",
            "address_purpose": "LOCATION",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447213349",
            "country_code": "US",
            "telephone_number": "330-470-4061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "AUTUMN",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-09",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2506755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208461",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISW",
            "identifier": "I.2506755",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mindy K. Waechter, NM LPCC AND OH LPC
• Lauren Waggoner, RBT
• Beth Wagner, PTA
• Hope M Wagner
• Jayson Wagner, DPT
• Jasmine M Wagster, MIDWIFE
• Emily Rose Waight, PA C
• Paraskevi Anastasia Waikem, SP12413
• Dominique Lasha Waiters
• Takesha Nicole Waiters

• Clinical Social Worker in Canton, OH
• Providers in Canton, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; 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.