Dr. Blake Douglas Wagner JR.
Psychologist
1575 Marion Ave
Mansfield
, Ohio 44906-3409
Dr. Blake Douglas Wagner JR.
Psychologist
1575 Marion Ave
Mansfield
, Ohio 44906-3409
(419) 529-0496
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About
Features
Specialties
- Psychologist
Languages spoken
- English
Location
First Address
- Dr. Blake Douglas Wagner JR.
- 1575 Marion Ave
- Mansfield, OH
- Zip : 44906-3409
- Fax : (419) 529-0496
- Phone : (419) 529-9941
Second Address
- Dr. Blake Douglas Wagner JR.
- 1575 Marion Ave
- Mansfield, OH
- Zip : 44906-3409
- Fax : (419) 529-0496
- Phone : (419) 529-9941
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 102L00000X | Psychologist | I-4127 | OH |
| Y | 103T00000X | Psychologist | I-4127 | OH |
National Provider Identifier
| NPI | 1013069061 |
|---|---|
| Provider Name | Dr. Blake Douglas Wagner JR. |
| First Address | Mansfield, OH 44906-3409 |
| Second Address | Mansfield, OH 44906-3409 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/01/2007 |
| Last Update Date | 02/09/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000315185 | ANTHEM (01) | |
| R71967 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.