Elizabeth Wagner, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5833 Issued in MN

Practice address

4500 Park Glen Rd
Suite 450
Saint Louis Park, MN 55416-4871

Phone

(952) 444-9744

Fax

(952) 444-9745

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

No

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elizabeth Wagner PSYD LP IncGroup PAC ID 4183967219, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Elizabeth Wagner, PSYD, LP, Inc.

  • Clinical Psychologist
  • Saint Louis Park, MN
  • NPI 1740637818
  Medicare reassignment Care Compare group NPD Authorized official
• The Compassion Boutique PC

  • Clinical Psychologist
  • St Louis Park, MN
  • NPI 1457175267
  NPD Authorized official

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1922128529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD",
            "address_2": "SUITE 450",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164871",
            "telephone_number": "952-444-9744",
            "fax_number": "952-444-9745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD",
            "address_2": "SUITE 450",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164871",
            "telephone_number": "952-444-9744",
            "fax_number": "952-444-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Punit D Wadhwa, MD
• Jessica G Wageman, PA-C
• David Bryan Waggonner, M.D.
• Kathy Wagle, APRN, CNS
• Elizabeth Wagner, LMFT
• Gina M Wagner, DPT
• Julie Ann Wagner, NP
• Mary D Wagner
• Sara Ellen Wagner, LICSW
• Scott Wagner, PT

• Clinical Psychologist in Saint Louis Park, MN
• Providers in Saint Louis Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.