Most Relevant Information
Provider Data
| NPI Number: | 1003827965 |
| Provider Name: | AMY W WAGNER PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103T00000X |
| Specialty: | Psychologist |
| License Number: | 2491 |
Most Important Dates
| Enumeration Date: | 08/10/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
3710 SW US VETERANS HOSPITAL RD
V3-SATP
PORTLAND
OR
972392964
Practice Location Phone/Fax
| Phone: | 5032208262 |
| Fax: | 3607371419 |
Provider Mailing Location
4205 NW SPRUCE ST
VANCOUVER
WA
986601655
Provider Mailing Phone/Fax
| Phone: | 3607500506 |
| Fax: |