Wagner, James A
Wagner, James A is an individual health care provider with primary practice located at 524 Main Street Suite 302, Racine WI 53403-1032. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Wagner, James A can be contacted via phone (262) 632-1780.Contact Information
Primary practice address
524 Main Street Suite 302
Racine WI 53403-1032
Phone: (262) 632-1780
Fax: (262) 632-0895
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 10328 | Wisconsin |
Profile Details
| NPI number | 1376718288 |
|---|---|
| LBN Legal business name | Wagner, James A |
| Credentials | CADCIII-RCS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 23rd, 2008 |
| Last updated | Apr 23rd, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376718288 | NPPES |
| Wisconsin | MEDICAID | 39172800 |
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