Individual
DR. PATRICK A WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
8424 NAAB RD STE 1L, INDIANAPOLIS, IN 46260-1954
(317) 338-7780
Mailing address
8424 NAAB RD STE 1L, INDIANAPOLIS, IN 46260-1954
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20010493A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100073410
—
IN
Enumeration date
07/08/2005
Last updated
09/08/2022
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