Organization
PATRICK A WAGNER PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK A WAGNER PHD (PSYCHOLOGIST/OWNER)
(317) 398-8146
Entity
Organization
Contact information
Practice address
1253 NORTH DEER RUN E DRIVE, SHELBYVILLE, IN 46176
(317) 398-8146
Mailing address
17330 W CENTER RD, SUITE 110-282, OMAHA, NE 68130-2392
(317) 446-9288
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20010493A
IN
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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