Organization
WAGNER & ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL WAGNER ED.D. (PSYCHOLOGIST)
(928) 445-5027
Entity
Organization
Contact information
Practice address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-5027
(928) 445-7071
Mailing address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-5027
(928) 445-7071
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1592
AZ
Other
Enumeration date
12/26/2007
Last updated
01/25/2012
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