| Nicole S. Wagner, Ph.d., Llc | |
|
11740 Clifton Blvd Suite 202 Lakewood OH 44107-2057 | |
| (216) 548-5469 | |
| Not Available |
| Full Name | Nicole S. Wagner, Ph.d., Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 11740 Clifton Blvd, Lakewood, Ohio |
| Authorized Official Name and Position | Nicole S Wagner (MANAGING PARTNER) |
| Authorized Official Contact | 2165485469 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole S. Wagner, Ph.d., Llc 11740 Clifton Blvd Suite 202 Lakewood OH 44107-2057 Ph: (216) 548-5469 | Nicole S. Wagner, Ph.d., Llc 11740 Clifton Blvd Suite 202 Lakewood OH 44107-2057 Ph: (216) 548-5469 |
| NPI Number | 1053589135 |
|---|---|
| Provider Enumeration Date | 02/12/2008 |
| Last Update Date | 02/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053589135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6025 (Ohio) | Primary |
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