Joel R. Wagaman, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY00002448 Issued in WA

Practice address

2118 Caton Way SW
Olympia, WA 98502-1105

Phone

(360) 352-6846

Fax

(360) 352-3289

NPI assigned

Dec 31, 2006

Sex

Male

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

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": "1167523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1952467045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 CATON WAY SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021105",
            "telephone_number": "360-870-6396",
            "fax_number": "360-352-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 CATON WAY SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021105",
            "telephone_number": "360-352-6846",
            "fax_number": "360-352-3289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984032232",
            "country_code": "US",
            "telephone_number": "360-352-6846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGAMAN",
        "first_name": "JOEL",
        "middle_name": "R.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-31",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WA",
            "license": "PY00002448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Jean Wade
• Kim Wadsworth, DO
• Wagaman Enterprises Inc
• Christina Wagaman, R.D.
• Jeffrey Daniel Wagaman, PH.D.
• Susan Lyn Wagaman, LMHCA
• John W. Waggoner III, M.D.
• Zoe Waggoner, MA, LMHC
• Binod Wagle, MD
• Emily Wagner

• Clinical Child & Adolescent Psychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Clinical Child & Adolescent Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.