Alicia Wagoner, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

8397 Issued in OH

Practice address

2675 Medway New Carlisle Rd
Medway, OH 45341-9744

Phone

(937) 856-7066

NPI assigned

May 11, 2018

Last updated

Oct 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wagoner's Psychological Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Medway, OH
  • NPI 1669250296
  NPD Authorized official
• Professional Counseling Services of Ohio LLC

  • Professional Counselor
  • Vandalia, OH
  • NPI 1073935649
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1265922504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 MEDWAY NEW CARLISLE RD",
            "city": "MEDWAY",
            "state": "OH",
            "postal_code": "453419744",
            "telephone_number": "937-856-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 MEDWAY NEW CARLISLE RD",
            "city": "MEDWAY",
            "state": "OH",
            "postal_code": "453419744",
            "telephone_number": "937-856-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "ALICIA",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-11",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "8397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Marie Kiss, LPN
• Chandler Phillips, M.D.
• Bethany A Rose, LPN
• Claudia Lee Shellabarger
• Michelle Renee Stafford, ATC
• Wagoner's Psychological Services, LLC
• Irene White
• Brooke A Willmeth

• Clinical Psychologist in Medway, OH
• Providers in Medway, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.