Individual
NICOLE S WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
29525 CHAGRIN BLVD STE 313, BEACHWOOD, OH 44122
(216) 548-5469
Mailing address
26047 BYRON DR, NORTH OLMSTED, OH 44070-1913
(216) 548-5469
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6025
OH
Other
Enumeration date
12/04/2006
Last updated
07/20/2022
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