Provider Demographics
NPI:1346550647
Name:WAGER, LAURA BETH (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BETH
Last Name:WAGER
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 LARK CT APT F
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1649
Mailing Address - Country:US
Mailing Address - Phone:317-706-0353
Mailing Address - Fax:
Practice Address - Street 1:403 LARK CT APT F
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1649
Practice Address - Country:US
Practice Address - Phone:317-706-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042456A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical