Provider Demographics
NPI:1275593048
Name:WAGAMAN, JANICE HAKES (MA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:HAKES
Last Name:WAGAMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:ANN
Other - Last Name:HAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:16C S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:PA
Mailing Address - Zip Code:17501-1331
Mailing Address - Country:US
Mailing Address - Phone:717-859-3531
Mailing Address - Fax:717-859-1060
Practice Address - Street 1:16C S 7TH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1331
Practice Address - Country:US
Practice Address - Phone:717-859-3531
Practice Address - Fax:717-859-1060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005911L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S34700Medicare UPIN