Individual
MRS. BERNEETA L WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
215 E WASHINGTON ST, CLARINDA, IA 51632-1625
(712) 542-3501
(712) 542-4725
Mailing address
215 E WASHINGTON ST, CLARINDA, IA 51632-1625
(712) 542-3501
(712) 542-4725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
00391
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0427013
IOWA MEDICAID ENTERPRISE
IA
01
—
129079
VALUE OPTIONS
—
01
—
58316
WELLMARK
—
05
—
6571310
—
SD
01
—
7320
MIDLANDS CHOICE
—
Enumeration date
10/11/2006
Last updated
12/18/2007
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