Provider Demographics
NPI:1144539123
Name:WAGONER, MEGAN C (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:C
Last Name:WAGONER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:CLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4860 RAINIER AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-6305
Mailing Address - Country:US
Mailing Address - Phone:360-513-1888
Mailing Address - Fax:888-797-7376
Practice Address - Street 1:4860 RAINIER AVE S STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6305
Practice Address - Country:US
Practice Address - Phone:360-513-1888
Practice Address - Fax:888-797-7376
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8919794OtherMEDICARE ID