Active NPI
Robert Michael Wagner, LP
- Psychologist
- St. Paul, MN
National Provider Identifier
1982875852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP4010
- Practice address
- 160 East Kellogg Blvd.
Suite 8500
St. Paul, MN 55101 - Phone
- (651) 266-3933
- NPI assigned
- Mar 18, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP4010 | MN | Primary |
Addresses
Primary practice location
160 East Kellogg Blvd.
Suite 8500
St. Paul, MN 55101
Mailing address
2703 Snowdrift Cir E
Maplewood, MN 55119-5993
Phone (612) 272-2255
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4010 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205798400000",
"number": "1982875852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2703 SNOWDRIFT CIR E",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551195993",
"telephone_number": "612-272-2255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 EAST KELLOGG BLVD.",
"address_2": "SUITE 8500",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55101",
"telephone_number": "651-266-3933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ROBERT",
"middle_name": "MICHAEL",
"credential": "LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-18",
"last_updated": "2008-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP4010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St. Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.