| Doctor Name: | DR. WILLIAM ROBERT WAGNER |
| NPI Number: | 1043219587 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DRNP, LCSW |
| License Number: | R055430 |
| Business Practice Address: | 1000 Health Center Road Kyle Health Center / Dhhs/ihs Kyle, SD - 57752 |
| Business Phone Number: | 9176269011 |
| Business Fax Number: | |
| Mailing Address: | 1000 Health Center Road, Kyle Health Center / Dhhs/ihs KYLE |
| State: | SD |
| Postal Code: | 57752 |
| Phone Number: | 9176269011 |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 04/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R055430 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |