| Dr Ivy Christine Wagner, DBH, LCSW | |
|
780 2nd St Se Ste 10, Bandon, OR 97411-8354 | |
| (541) 329-2144 | |
| Not Available |
| Full Name | Dr Ivy Christine Wagner |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 780 2nd St Se Ste 10, Bandon, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346754702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | L11519 (Oregon) | Primary |
| Entity Name | Bandon Community Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033348289 PECOS PAC ID: 1557416757 Enrollment ID: O20100430000431 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Ivy Christine Wagner, DBH, LCSW 790 Bluff Ave Sw, Bandon, OR 97411-9614 Ph: (503) 984-9243 | Dr Ivy Christine Wagner, DBH, LCSW 780 2nd St Se Ste 10, Bandon, OR 97411-8354 Ph: (541) 329-2144 |
Tracy Ann Merriam, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 110 10th St Se, Bandon, OR 97411 Phone: 541-347-5191 Fax: 541-266-4578 | |
Mrs. Susan Lynn Dimock, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1212 Alabama St, Suite 27, Bandon, OR 97411 Phone: 541-347-7090 | |
Mrs. Nicole Lavee Woolley, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2927 Ruby Ct, Bandon, OR 97411 Phone: 714-860-9433 |