Individual
DR. NATHAN S WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS--008851-L
PA
103TC0700X
Clinical Psychologist
071.007585
IL
103TC0700X
Clinical Psychologist
Primary
PSY000.4998
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01965831
—
PA
01
—
477318
VALUE OPTIONS
IL
01
—
588446000
MAGELLAN
IL
01
—
7599513
AETNA
IL
Enumeration date
04/11/2006
Last updated
07/23/2020
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