| Doctor Name: | LISA ELIZABETH WAGNER |
| NPI Number: | 1629182225 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW |
| License Number: | I0009675 |
| Business Practice Address: | 405 N Main St Kenton, OH - 433261375 |
| Business Phone Number: | 4196795994 |
| Business Fax Number: | 4192258878 |
| Mailing Address: | 441 E 8th St, LIMA |
| State: | OH |
| Postal Code: | 458042482 |
| Phone Number: | 4192213072 |
| Fax Number: | 4195495670 |
| NPI Enumeration Date: | 08/19/2006 |
| NPI Last Update Date: | 01/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I0009675 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |