Autumn Wagoner, LISW in Canton, OH - Medicare Social Worker Provider

Autumn Wagoner, LISW is a medicare enrolled "Social Worker - Clinical" provider in Canton, Ohio. Her current practice location is 4641 Fulton Dr Nw, Canton, Ohio. You can reach out to her office (for appointments etc.) via phone at (330) 433-6075.

Autumn Wagoner is licensed to practice in Ohio (license number I.2506755) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1962875245.

Contact Information

	Autumn Wagoner, LISW
	4641 Fulton Dr Nw, Canton, OH 44718-2384
	(330) 433-6075
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Autumn Wagoner
Gender	Female
Speciality	Social Worker - Clinical
Location	4641 Fulton Dr Nw, Canton, Ohio
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1962875245
Provider Enumeration Date: 11/09/2015
Last Update Date: 10/09/2025

Medicare PECOS Information:

PECOS PAC ID: 1557661311
Enrollment ID: I20151130001181

Medical Identifiers

Medical identifiers for Autumn Wagoner such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1962875245	NPI	-	NPPES
0208461	Medicaid	OH
I.2506755	Other	OH	LISW

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	I.2506755 (Ohio)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Autumn Wagoner allows following entities to bill medicare on her behalf.

Entity Name	Deer Oaks Mental Health Associates Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1134175763 PECOS PAC ID: 2264337013 Enrollment ID: O20240620003178

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Autumn Wagoner is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Autumn Wagoner, LISW 4641 Fulton Dr Nw, Canton, OH 44718-2384 Ph: (330) 433-6075	Autumn Wagoner, LISW 4641 Fulton Dr Nw, Canton, OH 44718-2384 Ph: (330) 433-6075

Reviews and Comments

Social Worker in Canton, OH

Kathleen Terry, LISW-S Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4368 Dressler Rd Nw Ste 103, Canton, OH 44718 Phone: 330-433-1300 Fax: 330-494-0828
Mark Woods, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 624 Market Ave N, Canton, OH 44702 Phone: 330-454-7066
Randall Devney, LSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4895 Dressler Rd Nw, Canton, OH 44718 Phone: 330-493-0083
Kristina Marie Drummer, LISW-S Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 400 Tuscarawas St W, Canton, OH 44702 Phone: 330-438-2400
Susan Stroup, LISW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 624 Market Ave N, Canton, OH 44702 Phone: 330-454-7066
Nicholas Fulks, Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 400 Tuscarawas St W, Canton, OH 44702 Phone: 330-438-2400 Fax: 330-823-7078
Kate Kelly, LSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4895 Dressler Rd Nw, Canton, OH 44718 Phone: 330-493-0083

Autumn Wagoner, LISW - Medicare Clinical Social Worker in Canton, OH