| Doctor Name: | KRISTEN ANN WAGNER |
| NPI Number: | 1144269846 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW, LCSW-R |
| License Number: | R058112-1 |
| Business Practice Address: | 183 Nightingale Way Shepherdsville, KY - 401656329 |
| Business Phone Number: | 5182104735 |
| Business Fax Number: | |
| Mailing Address: | 183 Nightingale Way, SHEPHERDSVILLE |
| State: | KY |
| Postal Code: | 401656329 |
| Phone Number: | 5182104735 |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2006 |
| NPI Last Update Date: | 07/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R058112-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| 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 |