Allison Wagner, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

32859 Issued in CA

Practice address

4510 Executive Drive Suite 315
San Diego, CA 92121-2360

Phone

(203) 667-6097

NPI assigned

Apr 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1699304311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DR STE 315",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213029",
            "telephone_number": "203-667-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DRIVE SUITE 315",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212360",
            "telephone_number": "203-667-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ALLISON",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-04",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Wafer
• Samuel Wagg, D.C.
• John P Waggoner, MD, MPH
• William H Waggoner, M.D.
• Bonnie Wagner Wikler, PH.D.
• Briana Darby Wagner, MFT
• Cassidy Leigh Wagner, PT, DPT
• Chris D Wagner, LCSW
• Cristian Eastwood Wagner
• David William Wagner, R.N.

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; 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.