Melissa Wagner, M.A.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSB94020935 Issued in CA

Practice address

3443 W Shaw Ave
Fresno, CA 93711-3249

Phone

(559) 271-1186

NPI assigned

Sep 10, 2014

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• House Psychiatric Clinic, Inc.

  • Psychiatry Physician
  • Fresno, CA
  • NPI 1235314246
  Medicare reassignment NPD

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1366843229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3443 W SHAW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113249",
            "telephone_number": "559-271-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 W SHAW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113249",
            "telephone_number": "559-271-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MELISSA",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-10",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSB94020935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Jane Wage, M.A., CCC-SLP
• Alyssa Nicole Wagner
• Andrew Wagner, CRNA
• Anneliese Wagner
• Janine Marie Wagner, LMFT
• Mildred Gayamo Wagner
• Eric Matthew Wagoner, PA-C
• Jacquelynn Wagoner, DO
• Sharon Wahyudi
• Wai S. Lee MD, Professional Corporation

• Clinical Psychologist in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.