Individual
GWENDOLYNE MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 THE ALAMEDA, SAN JOSE, CA 95126-1136
(408) 261-7777
(408) 261-8299
Mailing address
PO BOX 2234, SUNNYVALE, CA 94087-0234
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
26282
CA
Other
Enumeration date
10/28/2009
Last updated
12/01/2016
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