Blake Douglas Wagner in Mansfield - Psychologist
Blake Douglas Wagner - NPI 1013069061
Blake Douglas Wagner is a Psychologist in Mansfield, Ohio. Blake Douglas Wagner practices all healthcare services and medical treatments related to Psychologist. The NPI Number for Blake Douglas Wagner is 1013069061. The last update date is 2008-09-02.
Blake Douglas Wagner's current location address is 1575 Marion Ave, Mansfield, Ohio. You can contact this provider via phone number 4195299941 and fax number 4195290496. The mailing address for Blake Douglas Wagner is 1575 Marion Ave, Mansfield, Ohio. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Blake Douglas Wagner |
|---|---|
| Address | 1575 Marion Ave, Mansfield, Ohio |
| Phone Number | 4195299941 |
| Fax Number | 4195290496 |
| Sole Proprietor | N |
| Credentials | PH.D. |
NPI Number Detail
| NPI Number | 1013069061 |
|---|---|
| Provider Enumeration Date | 2007-01-18 |
| Last Updated Date | 2008-09-02 |
Provider Mailing Address Detail
| Address | 1575 Marion Ave |
|---|---|
| City | Mansfield |
| State | Ohio (OH) |
| Post Code | 449063409 |
| Phone Number | 4195299941 |
| Fax Number | 4195290496 |
Provider's Primary Taxonomy Detail
| Speciality | Psychologist |
|---|---|
| Taxonomy | 103T00000X |
| Licence No | I-4127 |
|
Definition: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and proce |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 315185 | ANTHEM |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Blake Douglas Wagner by the Centers for Medicare & Medicaid Services?
The Blake Douglas Wagner has been issued the NPI (National Provider Identifier) 1013069061, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you kindly provide the complete physical address where Blake Douglas Wagner's facilities are geographically located?
The facilities of Blake Douglas Wagner are physically situated at the following location: 1575 Marion Ave, Mansfield, OH, 449063409.
What is Blake Douglas Wagner's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Blake Douglas Wagner is Psychologist, and the taxonomy code that categorizes this field of expertise is 103T00000X.
When did Blake Douglas Wagner receive its 1013069061 assignment?
The Blake Douglas Wagner was assigned its 1013069061 on 2007-01-18, which is the date when this unique identifier was issued to the organization.
When was the information regarding Blake Douglas Wagner, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Blake Douglas Wagner, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2008-09-02.