Mr Jacob Arnold Wagner, LSP, EDS is a
Psychologist - School based in Cleveland, Tennessee. Mr Jacob Arnold Wagner is licensed to practice in Tennessee (license number 000748846) and his current practice location is
2292 Chambliss Ave Nw Ste C2, Cleveland, Tennessee. He can be reached at his office (for appointments etc.) via phone at
(423) 479-5672.
NPI number for Mr Jacob Arnold Wagner is 1497590277 and his current mailing address is 2292 Chambliss Ave Nw Ste C2, Cleveland, Tennessee. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1497590277.
Healthcare Provider's Profile
| Full Name | Mr Jacob Arnold Wagner |
|---|
| Gender | Male |
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| Speciality | Psychologist - School |
|---|
| Location | 2292 Chambliss Ave Nw Ste C2, Cleveland, Tennessee |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1497590277
- Provider Enumeration Date: 06/25/2024
- Last Update Date: 06/25/2024
Medical Identifiers
Medical identifiers for Mr Jacob Arnold Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1497590277 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YS0200X | Counselor - School | (* (Not Available)) | Secondary |
| 103TS0200X | Psychologist - School | 000748846 (Tennessee) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jacob Arnold Wagner is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Jacob Arnold Wagner, LSP, EDS
2292 Chambliss Ave Nw Ste C2,
Cleveland, TN 37311-3862
Ph: (423) 479-5672 | Mr Jacob Arnold Wagner, LSP, EDS
2292 Chambliss Ave Nw Ste C2,
Cleveland, TN 37311-3862
Ph: (423) 479-5672 |
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