Wagner, Michael Dale

Wagner, Michael Dale is an sole proprietor health care provider with primary practice located at 5415 Medallion Dr W , Westerville OH 43082-9194. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Wagner, Michael Dale can be contacted via phone (614) 218-8769.

Contact Information

Primary practice address
5415 Medallion Dr W Westerville OH 43082-9194
Phone: (614) 218-8769
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 4636 Ohio
Behavioral Health & Social Service Providers / Clinical 103TC0700X 4636 Ohio

Profile Details

NPI number 1760577340
LBN Legal business name Wagner, Michael Dale
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 3rd, 2006
Last updated Jun 20th, 2020 - about 4 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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