Organization
MARILYN M. WAGNER PH.D., PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARILYN M WAGNER PHD (PRESIDENT)
(502) 893-4011
Entity
Organization
Contact information
Practice address
105A CRESCENT AVE, LOUISVILLE, KY 40206-1525
(502) 893-4011
Mailing address
105A CRESCENT AVE, LOUISVILLE, KY 40206-1525
(502) 893-4011
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
0553
KY
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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