| Organization Name: | KATHLEEN J WAGNER LCSW |
| NPI Number: | 1013257302 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHLEEN WAGNER (DIRECTOR) |
| Mailing Address: | 820 Division St Billings |
| State: | MT US |
| Postal Code: | 591012049 |
| Phone Number: | 4062451338 |
| Fax Number: | 4062945226 |
| NPI Enumeration Date: | 02/22/2013 |
| NPI Last Update Date: | 03/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 785 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |