Individual
DR. DAVID WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(503) 494-7899
(503) 494-6868
Mailing address
8002 SW 37TH AVE, PORTLAND, OR 97219-3604
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2558
OR
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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