| Doctor Name: | STEPHEN LEE WAGNER |
| NPI Number: | 1114396694 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.S. |
| License Number: | KU1007163 |
| Business Practice Address: | 38720 Saltwell Rd Lisbon, OH - 444328303 |
| Business Phone Number: | 3304249591 |
| Business Fax Number: | 3304249481 |
| Mailing Address: | 38720 Saltwell Rd, LISBON |
| State: | OH |
| Postal Code: | 444328303 |
| Phone Number: | 3304249591 |
| Fax Number: | 3304249481 |
| NPI Enumeration Date: | 09/15/2015 |
| NPI Last Update Date: | 09/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | KU1007163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |