Individual
SEAN M. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCP
Contact information
Practice address
760 W D AVE, KINGMAN, KS 67068-1266
(620) 532-3895
Mailing address
419 E C AVE, KINGMAN, KS 67068-1622
(620) 532-2513
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0196
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
393288
BCBS
KS
Enumeration date
09/20/2006
Last updated
07/08/2007
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