Individual
ALICIA ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LIMHP, LCSW, LADC
Contact information
Practice address
1909 VICKI LN STE 105, NORFOLK, NE 68701-4542
(402) 256-7883
Mailing address
1909 VICKI LN STE 105, NORFOLK, NE 68701-4542
(402) 256-7883
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4490
NE
1041C0700X
Clinical Social Worker
Primary
1556
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10028558800
—
NE
Enumeration date
11/01/2017
Last updated
12/23/2023
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