Individual
DR. AMY W WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, V3-SATP, PORTLAND, OR 97239-2964
(503) 220-8262
(360) 737-1419
Mailing address
4205 NW SPRUCE ST, VANCOUVER, WA 98660-1655
(360) 750-0506
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2491
WA
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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