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AUTUMN WAGONER LISW
NPI 1962875245
Social Worker - Clinical in Canton, OH

Active since November 09, 2015PECOS Enrolled
4641 FULTON DR NW, CANTON, OH 44718(330) 433-6075 Get Directions Write a Review

NPPES record last updated: October 9, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 9, 2025, Nov 9, 2015 (2 updates tracked since 2015).

About Autumn Wagoner Lisw NPPES

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

AUTUMN WAGONER LISW (NPI 1962875245) is an individual clinical provider in Canton, Ohio, licensed in Ohio (I.2506755) and active in the NPI registry since November 2015. She is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1962875245
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameAUTUMN WAGONERCredential: LISW
Location Address4641 FULTON DR NWCanton, OH 44718-2384
Mailing Address4641 Fulton Dr NwCanton, OH 44718-2384 · (330) 433-6075
Phone(330) 433-6075
Sole ProprietorNo
Enumeration DateNovember 9, 2015
Last NPPES UpdateOctober 9, 20252 updates tracked since enumeration
NPPES CertifiedOctober 9, 2025
✔ NPI 1962875245 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in OH · I.2506755
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4641 FULTON DR NW, Canton, OH 44718
Open in Google Maps ↗

Secondary Practice Locations 3

Location 1405 S Linden AveAlliance, OH 44601-3035 · Phone (330) 433-6075
Location 2919 2nd St NECanton, OH 44704-1132 · Phone (330) 454-7917 · Fax (330) 454-7917
Location 31801 SCHNEIDER ST NECANTON, OH 44721-3349 · Phone (330) 470-4061

Other Identifiers 2

Medicaid0208461OH
OtherI.2506755OH · Lisw

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, MedMutual, Oscar Health Insurance and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Autumn Wagoner Lisw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Autumn Wagoner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Deer Oaks Mental Health Associates PC
1,519 mi
Clinical
3025 TERRACE DR
Las Cruces, NM 88011
  • Reassigned Medicare billing, Ohio enrollment
  • 21 clinicians in this Medicare group
NPI 1134175763 (888) 365-6271

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 44718 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.34 – $166.65
Typical copayment $0.00 (range $13.58 – $41.66)
Most-billed visit code NA
Established Patient
$68.07 typical visit price
range $17.10 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

HEATHER ANNE STRANGE
Community Health Worker
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
CRAIG DENNIS KING RN, APRN
Nurse Practitioner (Psychiatric/Mental Health)
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
DR. CYNTHIA K HA PH.D.
Student in an Organized Health Care Education/Training Program
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
EMMA JOAN FARKAS PSY.D.
Psychologist (Clinical)
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
LORNA O'DELL WRIGHT PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
ELLEN HOMLONG PC, RD,LD,CDE
Counselor (Professional)
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
ZIPPORAH MOORE
Case Manager/Care Coordinator
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075
ASHLEY E POKLAR MED
Student in an Organized Health Care Education/Training Program
4641 FULTON DR NW
CANTON, OH 44718
Stark County (330) 433-6075

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 Autumn Wagoner's NPI number?

The NPI number for Autumn Wagoner is 1962875245. It was assigned to this individual provider in the NPPES registry on November 9, 2015.

Where is Autumn Wagoner located?

Autumn Wagoner practices at 4641 Fulton Dr NW, Canton, OH 44718. The listed phone number is (330) 433-6075.

What is Autumn Wagoner's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Autumn Wagoner enrolled in Medicare?

Yes. Autumn Wagoner is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Autumn Wagoner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Autumn Wagoner reassigns Medicare benefits to Deer Oaks Mental Health Associates PC (Las Cruces, NM). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Autumn Wagoner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Autumn Wagoner accept?

Health plans from Anthem Blue Cross and Blue Shield, MedMutual, Oscar Health Insurance, Oscar Insurance Corporation of Ohio and UnitedHealthcare list Autumn Wagoner as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Autumn Wagoner was last updated on October 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.