Provider Demographics
NPI:1083409866
Name:WAGNER, BARRY THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:THOMAS
Last Name:WAGNER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 OXBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7227
Mailing Address - Country:US
Mailing Address - Phone:317-727-1963
Mailing Address - Fax:
Practice Address - Street 1:1613 W RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-1012
Practice Address - Country:US
Practice Address - Phone:765-285-4422
Practice Address - Fax:765-285-5632
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist