Provider Demographics
NPI:1437255098
Name:WAGNER, JOAN LYNN (MA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LYNN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:LYNN
Other - Last Name:MCKEAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 N WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1029
Mailing Address - Country:US
Mailing Address - Phone:714-526-2005
Mailing Address - Fax:
Practice Address - Street 1:217 W CERRITOS AVE BLDG 8
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6549
Practice Address - Country:US
Practice Address - Phone:714-254-8473
Practice Address - Fax:714-254-8480
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health