| Doctor Name: | MS. KARI SUE WAGNER |
| NPI Number: | 1073640595 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | 4340 |
| Business Practice Address: | 201 Kendall Drive Lamar, CO - 81052 |
| Business Phone Number: | 7193367501 |
| Business Fax Number: | 7193367453 |
| Mailing Address: | 1801 S 10th St, LAMAR |
| State: | CO |
| Postal Code: | 810524142 |
| Phone Number: | 2243661517 |
| Fax Number: | |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4340 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |