DR. Blake Douglas Wagner JR., PH.D.

NPI #1013069061 in Mansfield, Ohio

Provider Information

NPI Number
1013069061
Entity Type
Individual
Name
DR. Blake Douglas Wagner JR., PH.D.
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Psychologist
Credential
PH.D.
Enumeration Date
Jan 18, 2007
Last Updated
Sep 2, 2008

Practice Location

Address
1575 MARION AVE
State
Ohio
ZIP Code
44906-3409
Phone
(419) 529-9941

Specialties & Taxonomy Codes

Specialty
Psychologist

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