| |
4860 Rainier Ave S Ste C Seattle WA 98118-6305 | |
(360) 513-1888 | |
(888) 797-7376 |
Full Name | |
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Speciality | Psychologist |
Location | 4860 Rainier Ave S Ste C, Seattle, Washington |
Authorized Official Name and Position | Megan C Wagoner (SOLE OWNER) |
Authorized Official Contact | 3605131888 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4860 Rainier Ave S Ste C Seattle WA 98118-6305 Ph: (360) 513-1888 | 4860 Rainier Ave S Ste C Seattle WA 98118-6305 Ph: (360) 513-1888 |
NPI Number | 1801436480 |
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Provider Enumeration Date | 01/10/2020 |
Last Update Date | 10/26/2022 |
Certification Date | 10/26/2022 |
Medicare PECOS PAC ID | 6204262199 |
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Medicare Enrollment ID | O20200213000815 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801436480 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Megan C Wagoner |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1144539123 PECOS PAC ID: 6709026883 Enrollment ID: I20130715000037 |
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