JONATHAN ERIC WAGNER LPCC NPI 1063006724

NPI Information

  • NPI: 1063006724
  • Provider Name: JONATHAN ERIC WAGNER, LPCC
  • Classification: Counselor - 101YP2500X
  • Specialization: Professional
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2270 FORD PKWY STE 106
    SAINT PAUL, MN
    ZIP 55116
  • Phone: (612) 915-0049

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NPI Details

Jonathan Eric Wagner, LPCC is a professional counselor in Saint Paul, MN with 12 years of experience. Jonathan Eric Wagner, LPCC NPI is 1063006724. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2270 FORD PKWY STE 106
SAINT PAUL, MN
ZIP 55116-412
Phone: (612) 915-0049

The NPI 1063006724 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 2/23/2021 and was last updated on 5/1/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental Health02291MINNESOTANo
2101YP2500XCounselorProfessional4525MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
102291OTHERMINNESOTASTATE OF MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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