MEDICARE: MEGAN WAGONER PSYD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1801436480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGAN WAGONER PSYD PLLC

Provider Business Mailing Address
First Line	:	1037 NE 65TH ST # 82845
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6655
Country	:	US
Telephone Number	:	206-339-7327
Fax Number	:	888-797-7376

Provider Business Practice Location Address
First Line	:	4860 RAINIER AVE S STE C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-6305
Country	:	US
Telephone Number	:	360-513-1888
Fax Number	:	888-797-7376

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	MEGAN C WAGONER
Credential	:	PSYD
Telephone Number	:	206-339-7327

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	12/19/2025

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