Individual
DR. STEVE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1640 FLOSSIE DR, GREENDALE, IN 47025-8424
(859) 301-5901
(859) 301-5940
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-5901
(859) 301-5940
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040240A
IN
103TC0700X
Clinical Psychologist
20040240A
IN
103TC2200X
Clinical Child & Adolescent Psychologist
20040240A
IN
103TS0200X
School Psychologist
1008597
IN
Other
Enumeration date
08/12/2014
Last updated
03/06/2020
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