Paula Wagenbach, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1575 Issued in OR

Practice address

1818 NE Irving St
Portland, OR 97232-2238

Phone

(503) 421-0092

NPI assigned

Nov 16, 2006

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

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.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497828875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 NE IRVING ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322238",
            "telephone_number": "503-421-0092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 NE IRVING ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322238",
            "telephone_number": "503-421-0092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENBACH",
        "first_name": "PAULA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Wadsworth, LCSW
• Elizabeth Waechter Smith, CADC I
• Patricia Wafer
• Amy Linn Wagamon, PTA
• Shelly Wagar, LAC
• Karen A Wager, D.C.
• Melissa J Wages, DDS
• Haley Waggoner
• Leann Waggoner, CSWA
• Samuel Russell Waggoner

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.