SAMANTHA WAGNER (NPI# 1124524608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124524608 |
| Entity Type | Individual |
| Full Name | SAMANTHA WAGNER |
| Practice Address |
8616 Northern Ave Rockford IL 61107-5309 |
| Mailing Address |
1021 N Mulford Rd Rockford IL 61107-3877 |
| Practice Telephone | 8153328003 |
| Practice Fax Number | 8153326090 |
| Mailing Telephone | 8153875600 |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-04-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 104100000X | Social Worker | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770943078 | Samantha Ann Wagner | Specialist/Technologist | 170 Athletic Ctr, Stillwater, OK 74078-0001 | 2016-02-29 |
| 1083245781 | Samantha Nicole Wagner | Behavior Technician | 1563 Kingsley Ave Ste 103, Orange Park, FL 32073-4503 | 2020-01-31 |
| 1538631114 | Samantha Elizabeth Wagner | Nurse Practitioner | 209 9th St, Rockford, IL 61104-2235 | 2018-12-20 |
| 1689151391 | Samantha Wagner | Pharmacist | 410 W 10th Ave, 368 Doan Hall, Columbus, OH 43210 | 2018-07-25 |
| 1013415199 | Samantha Brooke Wagner | Counselor | 3230 Waring Ct Ste A, Oceanside, CA 92056-4509 | 2018-01-24 |
| 1598272429 | Samantha Rose Wagner | Social Worker | 8261 Market St, Boardman, OH 44512-6254 | 2017-12-31 |
| 1528595394 | Samantha Louise Wagner | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2017-05-11 |
| 1508311622 | Samantha M Wagner | Registered Nurse | 191 N Main St, Wellsville, NY 14895-1150 | 2016-08-18 |
| 1134559966 | Samantha Wagner | Behavioral Analyst | 16782 Von Karman Ave Ste 11, Irvine, CA 92606 | 2013-11-14 |
| 1669801791 | Samantha Wagner | Social Worker | 30 Prospect Ave, Hackensack, NJ 07601-1914 | 2013-11-08 |
| Street Address |
8616 NORTHERN AVE |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-5309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245217959 | Raymond Christopher Garcia | Psychiatry & Neurology | 8616 Northern Ave, Rockford, IL 61107-5309 | 2005-12-23 |
| 1659930956 | Margaret L Loy | Psychologist | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-06-10 |
| 1366005779 | Jacob Urbelis | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-04-22 |
| 1679032692 | Asia E Mueller | Registered Nurse | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1134688179 | Lori Martineau | Social Worker | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1669931689 | Christina Renee Kelley | Registered Nurse | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1497220388 | Jermaine E Tolefree | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-10-08 |
| 1699253617 | Lakeysha Watkins | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-08-01 |
| 1528546587 | Kelsey E Hayes | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-08-01 |
| 1417435652 | Shannon Marie Ferriter | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 104100000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. |
| Notes: Source: National Association of Social Workers, 2009 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881249621 | Sonia Castaneda | Social Worker | 4920 E State St Ste B, Rockford, IL 61108-2272 | 2019-08-08 |
| 1386195436 | Sara Wassenaar | Social Worker | 10060 Wolven Ave Ne, Rockford, MI 49341-9118 | 2016-10-24 |
| 1447706296 | Andrea Tack | Social Worker | 3690 Laura Ln, Rockford, IL 61114-8179 | 2016-08-31 |
| 1588015606 | Chianta A. Jefferson | Social Worker | 335 Dawn Ave Apt 2, Rockford, IL 61107-5047 | 2016-06-30 |
| 1740635218 | Karin K Leden | Social Worker | 6653 Weaver Rd Ste 105, Rockford, IL 61114-8052 | 2016-05-03 |
| 1285000893 | Matthew Matheny | Social Worker | 514 1/2 Chestnut St, Rockford, IL 61102-2265 | 2015-08-18 |
| 1417338799 | Latavia Shantaye Agada | Social Worker | 2823 Glenwood Ave., Rockford, IL 61101 | 2015-06-12 |
| 1912385568 | Elizabeth A Lawson | Social Worker | 4320 Spring Creek Rd Ste 16, Rockford, IL 61107-1157 | 2015-05-15 |
| 1396138350 | Jan Selander | Social Worker | 7294 Argus Dr, Rockford, IL 61107-5837 | 2015-03-13 |
| 1811266919 | Brian Klaung Msw Inc | Social Worker | 6975 Redansa Drive, Rockford, IL 61108-1201 | 2011-12-19 |
| Find all providers in ROCKFORD | ||||
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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.