Provider Demographics
NPI:1295215358
Name:WAGNER, MEGHAN CHRISTINE
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CHRISTINE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-6115
Mailing Address - Country:US
Mailing Address - Phone:971-645-6821
Mailing Address - Fax:
Practice Address - Street 1:1295 CRYSTAL LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:OR
Practice Address - Zip Code:97127-6115
Practice Address - Country:US
Practice Address - Phone:971-645-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst