| Doctor Name: | MS. CANDICE WAGENKNECHT |
| NPI Number: | 1083851075 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PLCSW |
| License Number: | 2008036911 |
| Business Practice Address: | 100 S Limit Ave Sedalia, MO - 653013655 |
| Business Phone Number: | 6608267909 |
| Business Fax Number: | 6608266737 |
| Mailing Address: | 100 S Limit Ave, SEDALIA |
| State: | MO |
| Postal Code: | 653013655 |
| Phone Number: | 6608267909 |
| Fax Number: | 6608266737 |
| NPI Enumeration Date: | 01/13/2009 |
| NPI Last Update Date: | 01/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2008036911 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |