Active NPI
Rebecca Wagner, PH.D.
- Clinical Psychologist
- Colorado Springs, CO
National Provider Identifier
1407900632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY.0005316
- Practice address
- 1259 Lake Plaza Dr Ste 255
Colorado Springs, CO 80906-3504 - Phone
- (719) 598-3585
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 1139 | SC | |
| Clinical Psychologist | 103TC0700X | PSY.0005316 | CO | Primary |
Addresses
Primary practice location
1259 Lake Plaza Dr Ste 255
Colorado Springs, CO 80906-3504
Mailing address
1259 Lake Plaza Dr Ste 255
Colorado Springs, CO 80906-3504
Phone (719) 598-3585
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS0478 | Medicaid | SC |
Other names 1
- Rebecca Iannuzzo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0005316 | CO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Counseling LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688947200000",
"number": "1407900632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1259 LAKE PLAZA DR STE 255",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809063504",
"telephone_number": "719-598-3585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1259 LAKE PLAZA DR STE 255",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809063504",
"telephone_number": "719-598-3585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "REBECCA",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2023-07-10",
"certification_date": "2023-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "SC",
"license": "1139",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSY.0005316",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS0478",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "IANNUZZO",
"credential": "PH.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.