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Contact Information

BLAKE D WAGNER JR, PhD
1575 MARION AVE
MANSFIELD, OH44906-3409
 Phone: 419-529-9941
 Fax: 419-529-0496
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BLAKE D WAGNER JR · (Male)

NPI # 1013069061
Status Active
Credentials PhD
Entity Individual
Enumeration date 01/18/2007
Last updated 09/02/2008 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • OH License # I-4127
  • Other 000000315185 ANTHEM
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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