Provider Demographics
NPI:1154988533
Name:WAGNER, LONDA SINNESS (MS, LMFT, IMH-E)
Entity type:Individual
Prefix:
First Name:LONDA
Middle Name:SINNESS
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, LMFT, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1264
Mailing Address - Country:US
Mailing Address - Phone:320-333-2746
Mailing Address - Fax:
Practice Address - Street 1:720 8TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3420
Practice Address - Country:US
Practice Address - Phone:320-407-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist