Wagoner, Scott T

Wagoner, Scott T is an individual health care provider with primary practice located at 705 Riley Hospital Dr , Indianapolis IN 46202-5109. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is his primary health care specialty. Wagoner, Scott T can be contacted via phone (317) 944-3774.

Contact Information

Primary practice address
705 Riley Hospital Dr Indianapolis IN 46202-5109
Phone: (317) 944-3774
Fax: (317) 944-8521
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Family 103TF0000X 20043486A Indiana
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 20043486B Indiana

Profile Details

NPI number 1134738057
LBN Legal business name Wagoner, Scott T
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2020
Last updated Jun 21st, 2022 - about 3 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 1134738057 NPPES
Indiana MEDICAID 300054621

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