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JILLICIA LEEANN WAGNER
NPI 1629839022
Peer Specialist in Port Huron, MI

Active since January 22, 2024
3111 ELECTRIC AVE, PORT HURON, MI 48060(810) 985-8900 Get Directions Write a Review

NPPES record last updated: January 22, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Jillicia Leeann Wagner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JILLICIA LEEANN WAGNER (NPI 1629839022) is an individual peer specialist in Port Huron, Michigan and active in the NPI registry since January 2024.

NPPES Registry Identity

NPI1629839022
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameJILLICIA LEEANN WAGNER
Location Address3111 ELECTRIC AVEPort Huron, MI 48060-8127
Mailing Address3111 Electric AvePort Huron, MI 48060-8127
Phone(810) 985-8900
Sole ProprietorNo
Enumeration DateJanuary 22, 2024
NPPES CertifiedJanuary 22, 2024
✔ NPI 1629839022 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
3111 ELECTRIC AVE, Port Huron, MI 48060
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. MARY E CROTEAU R.N.,B.S.N.
Registered Nurse
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
HEATHER STEWART LMSW
Social Worker (Clinical)
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
MICAELA ANNE CHAMPINE
Peer Specialist
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
CALLIE GUNN
Social Worker (Clinical)
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
JACQUELINE RENEE NICHOLS
Technician/Technologist
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
SHELBY RENEE GRAHAM
Case Manager/Care Coordinator
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
BRIAN FANION LMSW
Social Worker (Clinical)
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 985-8900
JORDAN FRONTIERO B.S
Peer Specialist
3111 ELECTRIC AVE
PORT HURON, MI 48060
St. Clair County (810) 966-3739

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jillicia Wagner's NPI number?

The NPI number for Jillicia Wagner is 1629839022. It was assigned to this individual provider in the NPPES registry on January 22, 2024.

Where is Jillicia Wagner located?

Jillicia Wagner practices at 3111 Electric Ave, Port Huron, MI 48060. The listed phone number is (810) 985-8900.

What is Jillicia Wagner's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Jillicia Wagner was last updated on January 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.