Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Sara Ellen Wagner, LICSW

Individual provider Clinical Social Worker · NPI 1912734245

Sara Ellen Wagner, LICSW is a Clinical Social Worker in St Louis Park, Minnesota. Qualified in 2022, 4 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2024
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

3525 Monterey Dr
St Louis Park, MN 55416-5275
Phone: (952) 993-6200
Fax: (952) 993-5631
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4801 Veterans Dr, Saint Cloud, MN 56303-2015 — (320) 255-6322

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 31139 (MN)

Record details

NPI number1912734245
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedSeptember 19, 2024
Last updated in NPPESJune 11, 2025
Certification dateJune 11, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in St Louis Park