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Individual

CYNTHIA A WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LLP

Contact information

Practice address
15209 W MICHIGAN AVE, MARSHALL, MI 49068-9570
(269) 781-9119
(269) 781-4347
Mailing address
15209 W MICHIGAN AVE, MARSHALL, MI 49068-9570
(269) 781-9119
(269) 781-4347

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301007919
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6301007919
LICENSE
MI
01
7509107630
BCBS OF MI
MI
Enumeration date
09/22/2006
Last updated
07/08/2013
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