Provider Demographics
NPI:1679851075
Name:WAGER, TERRENCE K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:K
Last Name:WAGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BLANKENSHIP RD
Mailing Address - Street 2:STE.200
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4172
Mailing Address - Country:US
Mailing Address - Phone:971-400-5544
Mailing Address - Fax:
Practice Address - Street 1:1800 BLANKENSHIP RD
Practice Address - Street 2:STE.200
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4172
Practice Address - Country:US
Practice Address - Phone:971-400-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2220103TA0400X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy