Wagner, Rebecca

Wagner, Rebecca is an individual health care provider with primary practice located at 1259 Lake Plaza Dr Ste 255 , Colorado Springs CO 80906-3504. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Wagner, Rebecca can be contacted via phone (719) 598-3585.

Contact Information

Primary practice address
1259 Lake Plaza Dr Ste 255 Colorado Springs CO 80906-3504
Phone: (719) 598-3585
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 1139 South Carolina
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY.0005316 Colorado

Profile Details

NPI number 1407900632
LBN Legal business name Wagner, Rebecca
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2007
Last updated Jul 10th, 2023 - about last year

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 1407900632 NPPES
South Carolina MEDICAID PS0478

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