ELIZABETH WAGNER (NPI# 1306062922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306062922 |
| Entity Type | Individual |
| Full Name | ELIZABETH WAGNER |
| Other Name | ELIZABETH PRUIETT |
| Credential | LCPC ATR-BC |
| Practice Address |
105 N Fair St Champaign IL 61821 |
| Mailing Address |
105 N Fair St Champaign IL 61821-3130 |
| Practice Telephone | 2173988090 |
| Mailing Telephone | 2173988090 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-11-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 180.003668 | IL | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
180.003668 | IL | Behavioral Health & Social Service Providers |
| N | 221700000X | Art Therapist | 00-105 | NC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215290465 | Elizabeth Ann Wagner | Music Therapist | 200 E. Curry Rd, 307c, Tempe, AZ 85281 | 2012-06-22 |
| 1104095306 | Elizabeth Forsythe Wagner | Physical Therapist | 11590 W Bernardo Ct Ste 100, San Diego, CA 92127-1624 | 2008-02-21 |
| 1134302565 | Elizabeth Wagner | Nutritionist | 1224 10th St Ste 207, Coronado, CA 92118-3420 | 2007-12-07 |
| 1285270512 | Elizabeth Clair Wagner | Behavior Technician | 8815 S Tacoma Way Ste 122, Lakewood, WA 98499-7011 | 2019-11-21 |
| 1174096481 | Elizabeth Wagner | Specialist | 1104 W River Rd, Detroit Lakes, MN 56501-2723 | 2019-01-09 |
| 1689158297 | Elizabeth Bramlish Wagner | Social Worker | 299 Cramer Creek Ct, Dublin, OH 43017-2586 | 2018-09-19 |
| 1003392044 | Elizabeth Bailey Wagner | Occupational Therapist | 7161 W Q Ave, Kalamazoo, MI 49009-5951 | 2018-07-12 |
| 1831629336 | Elizabeth Stanton Wagner | Pediatrics | 593 Eddy St, Providence, RI 02903-4923 | 2017-06-15 |
| 1386092336 | Elizabeth Ann Wagner | Nurse Practitioner | 222 S Woods Mill Rd Ste 500n, Chesterfield, MO 63017-3640 | 2016-06-01 |
| 1568822559 | Elizabeth Wagner | Community Health Worker | 8771 Westpointe Dr, Indianapolis, IN 46231-1169 | 2016-03-03 |
| Street Address |
105 N FAIR ST |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326532888 | Cunningham Children's Home of Urbana Il | Residential Treatment Facility, Emotionally Disturbed Children | 1303 N. Cunningham Avenue, Urbana, IL 61821 | 2018-06-19 |
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1457698169 | Mohamad Ata | Registered Nurse | 1802 S. Mattis, Champaign, IL 61821 | 2013-01-15 |
| 1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
| 1679850887 | Kirk Donald Gohsman | Counselor | 106 S. Country Fair Drive, Suite C, Champaign, IL 61821 | 2011-11-16 |
| 1598054777 | Delbert William Nelson Jr. | Psychiatry & Neurology | 2115 Galen Dr, Champaign, IL 61821 | 2011-03-28 |
| 1790946929 | Rdi Vein LLC | Clinic/Center | 2502 Galen Drive, Suite 101, Champaign, IL 61821 | 2008-06-20 |
| 1366620064 | Advanced Aesthetics Surgery & Laser Center, P.C. | Clinic/Center | 2111 West Park Ct., Champaign, IL 61821 | 2008-02-05 |
| 1033398482 | Huey's Home Medical, Inc | Durable Medical Equipment & Medical Supplies | 1207 S Mattis Ave Ste 1, Champaign, IL 61821 | 2007-11-01 |
| 1265630537 | Elizabeth Catherine Tingley | Psychologist | Department of Psychiatry and Psychology-carle Physician, 1802 S. Mattis, Champaign, IL 61821 | 2007-07-06 |
| Find all providers in zip 61821 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275143471 | Mariah Hanson | Counselor | 1011 Laura Dr, Champaign, IL 61822-2385 | 2020-08-03 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1750541256 | Lynn Randolph Watson | Counselor | 218 Brookwood, Champaign, IL 61820 | 2008-06-10 |
| 1043496425 | Lindsey Joy Francke | Counselor | 209 W University Ave, Apt 4, Champaign, IL 61820-3966 | 2008-01-15 |
| 1215131552 | Debra Frye | Counselor | 1112 Lincolnshire Dr, Champaign, IL 61821-5606 | 2007-06-12 |
| 1043434061 | Christine Johnson | Counselor | 702 Bloomington Rd Ste 214, Champaign, IL 61820-2560 | 2007-04-12 |
| 1316545296 | Mcgill Counseling | Counselor | 2919 Crossing Ct, Champaign, IL 61822-5903 | 2020-10-13 |
| 1609492669 | Dylan J Mahaffey | Counselor | 201 W Springfield Ave Ste 1005, Champaign, IL 61820-4968 | 2020-06-24 |
| 1730747510 | Ray Emerson Turner | Counselor | 1801 Fox Dr, Champaign, IL 61820-7236 | 2019-06-05 |
| 1932673779 | Cameron Hunter | Counselor | 1801 Fox Dr, Champaign, IL 61820-7236 | 2019-01-15 |
| Find all providers in CHAMPAIGN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.