DR. MICHAEL DALE WAGNER (NPI# 1760577340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760577340 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL DALE WAGNER |
| Credential | PHD |
| Practice Address |
5415 Medallion Dr W Westerville OH 43082-9194 |
| Practice Telephone | 6142188769 |
| Mailing Telephone | 6142188769 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-06-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
4636 | OH | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
4636 | OH | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5415 Medallion Dr W, Westerville, OH 430829194 | 6142188769 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700446267 | Michael Wagner | Dentist | 754 S Main St Ste 1, St George, UT 84770-5510 | 2019-06-17 |
| 1336655034 | Michael D Wagner | Custodial Care Facility | 807 Pine Ave Nw, Grand Rapids, MI 49504-4340 | 2017-12-18 |
| 1285169037 | Michael Wagner | Student in an Organized Health Care Education/Training Program | 4316 E Avalon Dr, #11, Phoenix, AZ 85018-7245 | 2017-04-28 |
| 1235585191 | Michael Charles Wagner | Occupational Therapist | 170 2nd St S, Nampa, ID 83651-3708 | 2016-05-10 |
| 1033555362 | Michael S Wagner | Marriage & Family Therapist | 3263 Sacramento St, Suite B, San Francisco, CA 94115-2054 | 2013-05-14 |
| 1013154293 | Michael James Wagner | Counselor | 10207 E Shady Rock Ln, Tucson, AZ 85749-8162 | 2009-01-09 |
| 1619159084 | Michael Paul Wagner | Chiropractor | 544e. North Ave, Glendale Heights, IL 60139 | 2007-11-28 |
| 1609903178 | Michael John Wagner | Dentist | 13515 Ne 175th St Ste G, Woodinville, WA 98072-8566 | 2007-02-28 |
| 1073655825 | Michael C Wagner II | Nurse Practitioner | 603 N Logan Ave, Danville, IL 61832-4320 | 2007-02-12 |
| 1083719942 | Michael E Wagner | Chiropractor | 8553 Hickman Rd, Urbandale, IA 50322-4321 | 2006-09-14 |
| Street Address |
5415 MEDALLION DR W |
| City | WESTERVILLE |
| State | OH |
| Zip Code | 43082-9194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023501509 | Taylor Wucinich | Audiologist | 387 County Line Rd W Ste 116, Westerville, OH 43082 | 2018-06-11 |
| 1366940132 | Hogan Nicklaus Marshall | Specialist/Technologist | 7118 Mount Royal Ave, Westerville, OH 43082 | 2018-01-26 |
| 1356858450 | Margaret Adams | Chiropractor | 387 County Line Rd. W, 215, Westerville, OH 43082 | 2018-01-10 |
| 1326407701 | Heidi A. Stauffer Dds | Dentist | 124 County Line Rd W, Suite A, Westerville, OH 43082 | 2016-02-15 |
| 1629324553 | Mavis Asamoah | Licensed Practical Nurse | 5401 Country Meadow Ct, Westerville, OH 43082 | 2012-07-30 |
| 1326283698 | Amy Lyn Gosnell | Dermatology | 300 Polaris Pkwy Ste 3300, Westerville, OH 43082 | 2008-12-15 |
| 1215186705 | Molly Hauer | Nursing Facility/Intermediate Care Facility | 7017 Laver Ln, Westerville, OH 43082 | 2008-09-09 |
| 1013181205 | Tridia Hospice Care, Inc. | Hospice Care, Community Based | 110 Polaris Pkwy Ste 302, Westerville, OH 43082 | 2008-04-17 |
| 1174702070 | Kathryn J Watkins Younkin | Dentist | 450 Alkyre Run Dr, Suite 290, Westerville, OH 43082 | 2007-10-26 |
| 1033300900 | Audrey Jones | Student in an Organized Health Care Education/Training Program | 187 W. Schrock Rd, Children's Hospital Guidance Center, Westerville, OH 43082 | 2007-08-06 |
| Find all providers in zip 43082 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729746 | Transformations Psychological Services, LLC | Psychologist | 167 S State St Ste 80, Westerville, OH 43081-2236 | 2020-04-22 |
| 1588913495 | Jinhui Wang | Psychologist | 598 Office Pkwy, Westerville, OH 43082-8053 | 2012-09-06 |
| 1609180900 | Donna Patricia Mcclure | Psychologist | 975 S. Sunbury Rd, Central College Christian Counseling, Westerville, OH 43081 | 2010-07-29 |
| 1154489276 | Bethany Ann Shaw | Psychologist | 167 S State St, Suite 100, Westerville, OH 43081-2265 | 2006-12-04 |
| 1447340781 | John M Malinky | Psychologist | 647 A Park Meadow Rd, Westerville, OH 43081 | 2006-10-16 |
| 1750320222 | Mary Bricker | Psychologist | 3 W Main St Ste 202, Westerville, OH 43081-2195 | 2006-06-06 |
| 1659939973 | Lisa Hoyman | Psychologist | 495 Cooper Rd Ste 212, Westerville, OH 43081-8735 | 2019-06-01 |
| 1073031399 | Lisa Sperle | Psychologist | 275 W Schrock Rd, Westerville, OH 43081-2874 | 2017-09-07 |
| 1861917163 | Jessie Richard | Psychologist | 187 W Schrock Rd, Westerville, OH 43081-2890 | 2017-08-08 |
| 1720516792 | Kevin George Stephenson | Psychologist | 187 W Schrock Rd, Westerville, OH 43081-2890 | 2017-06-02 |
| Find all providers in WESTERVILLE | ||||
| City | WESTERVILLE |
| Zip Code | 43082 |
Please comment or provide details below to improve the information on DR. MICHAEL DALE WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.