NPIMap

Organization Active NPI

Wagaman Enterprises Inc

  • Psychologist
  • Olympia, WA
National Provider Identifier
1740461854
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY 1722 Issued in WA
Legal business name
WAGAMAN ENTERPRISES INC
Practice address
2100 Caton Way SW
Olympia, WA 98502-1105
Phone
(360) 866-7406
Fax
(360) 570-3325
NPI assigned
Nov 16, 2007
Last updated
Jan 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

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

Authorized official

Name
Dr. Jeffrey Daniel Wagaman, PH.D.NPI 1447377221
Title
Owner/ President
Phone
(360) 866-7406

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY 1722 WA Primary

Addresses

Primary practice location

2100 Caton Way SW
Olympia, WA 98502-1105

Mailing address

2100 Caton Way SW
Olympia, WA 98502-1105
Phone (360) 866-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100614000312 WA Part B Supplier - Clinic/Group Practice 0345388641 Receives reassigned benefits from 7 practitioners
Practice locations: Olympia, WA

National Provider Directory

National Provider Directory

Locations

2100 Caton Way SW
Olympia, WA 98502
Phone (360) 866-7406

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1740461854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CATON WAY SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021105",
            "telephone_number": "360-866-7406",
            "fax_number": "360-570-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CATON WAY SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021105",
            "telephone_number": "360-866-7406",
            "fax_number": "360-570-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGAMAN ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "WAGAMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "360-866-7406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY 1722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.