Individual
AMANDA WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1825 4TH ST FL 5, SAN FRANCISCO, CA 94143-2350
(805) 558-0601
Mailing address
1825 4TH ST # 5A, SAN FRANCISCO, CA 94143-2350
(415) 502-1914
(415) 353-2400
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
30640
CA
Other
Enumeration date
09/10/2017
Last updated
05/21/2019
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