Provider Demographics
NPI:1538989843
Name:WAGNER, CATHERINE C (EDS)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:WAGNER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 BURGESS HILL PASS
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5858
Mailing Address - Country:US
Mailing Address - Phone:260-409-3938
Mailing Address - Fax:
Practice Address - Street 1:19500 TOMLINSON RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-6701
Practice Address - Country:US
Practice Address - Phone:317-867-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool