| Wagaman Enterprises Inc | |
|
2100 Caton Way Sw Olympia WA 98502-1105 | |
| (360) 866-7406 | |
| (360) 570-3325 |
| Full Name | Wagaman Enterprises Inc |
|---|---|
| Speciality | Psychologist |
| Location | 2100 Caton Way Sw, Olympia, Washington |
| Authorized Official Name and Position | Jeffrey Daniel Wagaman (OWNER/ PRESIDENT) |
| Authorized Official Contact | 3608667406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagaman Enterprises Inc 2100 Caton Way Sw Olympia WA 98502-1105 Ph: (360) 866-7406 | Wagaman Enterprises Inc 2100 Caton Way Sw Olympia WA 98502-1105 Ph: (360) 866-7406 |
| NPI Number | 1740461854 |
|---|---|
| Provider Enumeration Date | 11/16/2007 |
| Last Update Date | 01/25/2010 |
| Medicare PECOS PAC ID | 0345388641 |
|---|---|
| Medicare Enrollment ID | O20100614000312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740461854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY 1722 (Washington) | Primary |
| Provider Name | Jeffrey D Wagaman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447377221 PECOS PAC ID: 1850352832 Enrollment ID: I20041022000688 |
| Provider Name | Julie F Fogliano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952576522 PECOS PAC ID: 8820219678 Enrollment ID: I20141021001757 |
| Provider Name | Mary E Fredericks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306188032 PECOS PAC ID: 3870817349 Enrollment ID: I20150112001030 |
| Provider Name | Kristen N Pace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013435882 PECOS PAC ID: 6901238906 Enrollment ID: I20191113000739 |
| Provider Name | Jennifer D Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548823917 PECOS PAC ID: 7719314400 Enrollment ID: I20200218002175 |
| Provider Name | Ann Song |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861816449 PECOS PAC ID: 3072940337 Enrollment ID: I20200226000526 |
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