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MARILYN M WAGNER PH.D.

Clinical Neuropsychologist

Louisville, Kentucky

Provider NPI: 1598757213

Provider Information:
 MARILYN M WAGNER PH.D.
Gender: F


Practice Location:
7511 NEW LAGRANGE RD  LOUISVILLE, KY 40222 US
Tel: 502-423-1151  Fax: 502-423-1748

Business Mailing Address:
7511 NEW LAGRANGE RD  LOUISVILLE, KY 40222 US
Tel: 502-423-1151  Fax: 502-423-1748

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
KY553

Other Provider Identifiers:

IssuerNumberStateType
89007553KY05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS KY - Page 1

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