Active NPI
Terrence K Wager, PSY.D.
- Clinical Psychologist
- West Linn, OR
National Provider Identifier
1679851075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2220
- Practice address
- 1800 Blankenship Rd
Ste.200
West Linn, OR 97068-4172 - Phone
- (971) 400-5544
- NPI assigned
- Aug 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 2220 | OR | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 2220 | OR | |
| Clinical Psychologist | 103TC0700X | 2220 | OR | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2220 | OR | |
| Family Psychologist | 103TF0000X | 2220 | OR | |
| Forensic Psychologist | 103TF0200X | 2220 | OR | |
| Group Psychotherapy Psychologist | 103TP2701X | 2220 | OR |
Addresses
Primary practice location
1800 Blankenship Rd
Ste.200
West Linn, OR 97068-4172
Mailing address
1800 Blankenship Rd
Ste.200
West Linn, OR 97068-4172
Phone (971) 400-5544
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2220 | OR | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1679851075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 BLANKENSHIP RD",
"address_2": "STE.200",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970684172",
"telephone_number": "971-400-5544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 BLANKENSHIP RD",
"address_2": "STE.200",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970684172",
"telephone_number": "971-400-5544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGER",
"first_name": "TERRENCE",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-02",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "2220",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "2220",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2220",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "2220",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "OR",
"license": "2220",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "OR",
"license": "2220",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OR",
"license": "2220",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Linn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.