Provider Demographics
NPI:1164406872
Name:WANGSGAARD, SCOTT MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:WANGSGAARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 W GAGE BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8105
Mailing Address - Country:US
Mailing Address - Phone:509-948-8948
Mailing Address - Fax:509-943-4558
Practice Address - Street 1:8390 W GAGE BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8105
Practice Address - Country:US
Practice Address - Phone:509-948-8948
Practice Address - Fax:509-943-4558
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist