Lyle Walter Wagner III, PHD, LP

NPI #1649683939 in Coon Rapids, Minnesota

Provider Information

NPI Number: 1649683939
Entity Type: Individual
Name: Lyle Walter Wagner III, PHD, LP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Clinical
Credential: PHD, LP
Enumeration Date: Jun 4, 2014
Last Updated: Jun 4, 2014

Practice Location

Address: 3907 COON RAPIDS BLVD NW
City: Coon Rapids
State: Minnesota
ZIP Code: 55433-2520
Phone: (320) 629-7600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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