DR. JACQUELYN WRIGHT WAGNER (NPI# 1528428398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528428398 |
| Entity Type | Individual |
| Full Name | DR. JACQUELYN WRIGHT WAGNER |
| Credential | PSY.D. |
| Practice Address |
2500 Como Ave Saint Paul MN 55108-1460 |
| Mailing Address |
8170 33rd Ave S # Ms 21110q Minneapolis MN 55425-4516 |
| Practice Telephone | 6516416200 |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2020-09-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6159 | MN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1772 Steiger Lake Ln, Suite 200, Victoria, MN 553867723 | 9524434600 |
| Street Address |
2500 COMO AVE |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55108-1460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942295050 | Kara Serene Boyko Frandson | Pharmacist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2005-09-14 |
| 1205333275 | David Bryan Polley | Registered Nurse | 2500 Como Ave, Saint Paul, MN 55108 | 2018-04-06 |
| 1578065348 | Crystalyn Morton | Registered Nurse | 2500 Como Ave, Mail Stop 31100a, Saint Paul, MN 55108-1460 | 2018-03-07 |
| 1831610401 | Dema Mohammed | Pharmacist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-07-04 |
| 1225568520 | Lauren Michele Soukup | Optometrist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-06-19 |
| 1174059166 | Elliott Scott Foss | Physician Assistant | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-05-11 |
| 1376081133 | Estella Dennis | Registered Nurse | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-02-01 |
| 1619411808 | Katherine A. Becker | Physician Assistant | 2500 Como Ave, Saint Paul, MN 55108 | 2016-12-07 |
| 1821479403 | Karisa Jean Etter | Optometrist | 2500 Como Ave, Saint Paul, MN 55108 | 2015-06-09 |
| 1770979536 | Colin Thomas O'connor | Physician Assistant | 2500 Como Ave, Saint Paul, MN 55108 | 2015-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490677 | Kyle Leonard Bernier | Student in an Organized Health Care Education/Training Program | 1295 Bandana Blvd W, Suite 210, St. Paul, MN 55108 | 2019-07-25 |
| 1356870778 | Kathleen Louise Kocon | Marriage & Family Therapist | 2230 Como Ave., Saint Paul, MN 55108 | 2017-06-08 |
| 1871965830 | Jill Hansen | Specialist | 1449 Clevland Ave N, The Emily Program, Saint Paul, MN 55108 | 2015-10-29 |
| 1871821140 | Angela Joyce Anderson | Speech-Language Pathologist | 2266 Hillside Avenue, Saint Paul, MN 55108 | 2009-11-25 |
| 1265769418 | Dakota Baker | Counselor | 1360 Energy Park Drive Suite 340, St. Paul, MN 55108 | 2009-11-09 |
| 1255583449 | Suzanne Elizabeth Trunnell | Nurse Practitioner | 1020 Bandana Blvd. W, Aspen Medical Group--bandana Square, St. Paul, MN 55108 | 2008-10-21 |
| 1982851358 | Kimberly Joy Bahma | Pharmacist | 1295 Bandana Blvd, Suite 335, Saint Paul, MN 55108 | 2008-08-27 |
| 1952566093 | Caring Professionals Homecare, LLC | Home Health | 1543 Como Ave Ste 101, Saint Paul, MN 55108 | 2008-07-28 |
| 1700077344 | Archana Mani | Dentist | 1021 Bandana Blvd E Ste 121, Saint Paul, MN 55108 | 2007-08-08 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| Find all providers in zip 55108 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669992186 | Stephanie Bruss | Psychologist | 821 Raymond Ave # 130c, Saint Paul, MN 55114-1503 | 2017-06-26 |
| 1679977326 | Jennifer D. Karel | Psychologist | 1123 Grand Ave Ste 301, Saint Paul, MN 55105-2629 | 2014-10-09 |
| 1699038265 | Minnesota Organization On Fetal Alcohol Syndrome (mofas) | Psychologist | 2233 University Ave W Ste 395, Saint Paul, MN 55114-1600 | 2012-06-19 |
| 1821356098 | Mainhia Khang | Psychologist | 393 Dunlap St N Ste 105, Saint Paul, MN 55104-4211 | 2012-04-25 |
| 1609153378 | Quo Psychotherapy, P.a. | Psychologist | 821 Raymond Ave Ste 230c, Saint Paul, MN 55114-1525 | 2011-11-09 |
| 1831486216 | Bonnie Sue Mcmillin | Psychologist | 457 Portland Ave, 3, Saint Paul, MN 55102-2499 | 2011-07-06 |
| 1285935064 | Sarah L. Hart, Ph.d., LLC | Psychologist | 241 Cleveland Ave S Ste P, Saint Paul, MN 55105-1208 | 2010-11-09 |
| 1003149717 | Tamarind Knutson | Psychologist | 1360 Energy Park Dr Ste 340, Saint Paul, MN 55108-5298 | 2009-09-13 |
| 1659604874 | Andrea Elizabeth Anderson | Psychologist | 2383 University Ave W Ste 200, U.S. Bank Building, Second Floor, Saint Paul, MN 55114-1603 | 2009-09-08 |
| 1639307622 | Nicole Heffron, LLC | Psychologist | 889 Grand Ave, Suite 202, Saint Paul, MN 55105-3008 | 2009-06-29 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55108 |
Please comment or provide details below to improve the information on DR. JACQUELYN WRIGHT WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.