Individual
DR. MICHAEL DALE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5415 MEDALLION DR W, WESTERVILLE, OH 43082-9194
(614) 218-8769
Mailing address
5415 MEDALLION DR W, WESTERVILLE, OH 43082-9194
(614) 218-8769
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4636
OH
103TC2200X
Clinical Child & Adolescent Psychologist
4636
OH
Other
Enumeration date
10/03/2006
Last updated
06/20/2020
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