Individual
DR. JACQUELYN WRIGHT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2500 COMO AVE, SAINT PAUL, MN 55108-1460
(651) 641-6200
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6159
MN
Other
Enumeration date
03/07/2016
Last updated
09/16/2020
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