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Contact Information

LYLE W WAGNER JR, PHD
236 N SIBLEY AVE
LITCHFIELD, MN55355
 Phone: 320-693-7708
 Fax: 320-434-2176
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LYLE W WAGNER JR · (Male)

NPI Number 1972675486
Status Active
Credentials PHD
Entity Individual
Enumeration date 11/14/2006
Last updated 07/06/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # LP0681
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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