Individual
ROBERT MICHAEL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
160 EAST KELLOGG BLVD., SUITE 8500, ST. PAUL, MN 55101
(651) 266-3933
Mailing address
2703 SNOWDRIFT CIR E, MAPLEWOOD, MN 55119-5993
(612) 272-2255
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4010
MN
Other
Enumeration date
03/18/2008
Last updated
03/18/2008
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