Individual
MARIA CATHERINE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
318 1ST AVE SW STE 112, ROCHESTER, MN 55902-3624
(507) 208-4774
(507) 322-0019
Mailing address
318 1ST AVE SW STE 112, ROCHESTER, MN 55902-3624
(507) 208-4774
(507) 322-0019
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18844
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336496207
—
MN
01
—
800003101
MEDICARE PTAN# (INDIVIDUAL)
MN
Enumeration date
10/17/2011
Last updated
09/10/2025
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