Provider Demographics
NPI:1255412615
Name:WAGNER, JAMES ALLEN (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7708 OKANAGAN CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5386
Mailing Address - Country:US
Mailing Address - Phone:661-832-5991
Mailing Address - Fax:661-832-5991
Practice Address - Street 1:11301 WILSHIRE BL.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4781
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor