# SCOTT T WAGONER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1134738057
- **Gender:** Man
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 20043486B | IN | Yes |
| 103TF0000X | Family Psychologist | 20043486A | IN | — |

## Other

- **Enumeration date:** 07/27/2020
- **Last updated:** 02/07/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300054621 | — | IN |