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Organization

WAGNER ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KATHRYN PARKS WAGNER PH.D. (SECRETARY)
(865) 212-5301
Entity
Organization

Contact information

Practice address
679 EMORY VALLEY ROAD, SUITE B, OAK RIDGE, TN 37830
(865) 212-5301
(865) 220-0782
Mailing address
679 EMORY VALLEY ROAD, SUITE B, OAK RIDGE, TN 37830
(865) 212-5301
(865) 220-0782

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000000600
TN
103TC0700X
Clinical Psychologist
P0000001265
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3067696
BCBS
TN
05
3680317
TN
05
3682388
TN
01
78130
BCBS
TN
Enumeration date
12/01/2006
Last updated
08/22/2020
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