| Doctor Name: | LORI ANN WAGNER |
| NPI Number: | 1538542246 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | CC01011 |
| Business Practice Address: | 1385 Mendota Heights Rd Ste 200 Mendota Heights, MN - 551201289 |
| Business Phone Number: | 6513799800 |
| Business Fax Number: | |
| Mailing Address: | 1385 Mendota Heights Rd Ste 200, MENDOTA HEIGHTS |
| State: | MN |
| Postal Code: | 551201289 |
| Phone Number: | 6513799800 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2015 |
| NPI Last Update Date: | 07/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | CC01011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |