Individual
DAVID J WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
2019 RAMBLING RD, KALAMAZOO, MI 49008-1630
(269) 345-0909
(269) 345-4985
Mailing address
2019 RAMBLING RD, KALAMAZOO, MI 49008-1630
(269) 345-0909
(269) 345-4985
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301007764
MI
Other
Enumeration date
01/11/2007
Last updated
09/03/2008
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