Individual
DR. PAULA WAGENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1818 NE IRVING ST, PORTLAND, OR 97232-2238
(503) 421-0092
Mailing address
1818 NE IRVING ST, PORTLAND, OR 97232-2238
(503) 421-0092
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1575
OR
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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