Wagner, Marilyn M

Wagner, Marilyn M is an individual health care provider with primary practice located at 7511 New Lagrange Rd , Louisville KY 40222-4859. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Wagner, Marilyn M can be contacted via phone (502) 423-1151.

Contact Information

Primary practice address
7511 New Lagrange Rd Louisville KY 40222-4859
Phone: (502) 423-1151
Fax: (502) 423-1748
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 553 Kentucky

Profile Details

NPI number 1598757213
LBN Legal business name Wagner, Marilyn M
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598757213 NPPES
Kentucky MEDICAID 89007553

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