Individual
TRACI WAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LSW.0009920335
CO
104100000X
Social Worker
Primary
4482
KY
1041C0700X
Clinical Social Worker
0009920335
CO
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
03/23/2009
Last updated
09/23/2019
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