Scott T Wagoner
Clinical Child & Adolescent Psychologist
705 Riley Hospital Dr
Indianapolis
, Indiana 46202-5109
Scott T Wagoner
Clinical Child & Adolescent Psychologist
705 Riley Hospital Dr
Indianapolis
, Indiana 46202-5109
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About
Features
Specialties
- Clinical Child & Adolescent Psychologist
Languages spoken
- English
Location
First Address
- Scott T Wagoner
- 250 N Shadeland Ave
- Indianapolis, IN
- Zip : 46219-4959
- Phone :
Second Address
- Scott T Wagoner
- 705 Riley Hospital Dr
- Indianapolis, IN
- Zip : 46202-5109
- Fax : (317) 944-8521
- Phone : (317) 944-3774
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Is Scott T Wagoner accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 20043486B | IN |
National Provider Identifier
| NPI | 1134738057 |
|---|---|
| Provider Name | Scott T Wagoner |
| First Address | Indianapolis, IN 46219-4959 |
| Second Address | Indianapolis, IN 46202-5109 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/07/2020 |
| Last Update Date | 07/12/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 300054621 | (05) | IN |
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.