Healthcare Provider Details

I. General information

NPI: 1194944025
Provider Name (Legal Business Name): LINDA A WAGASKY RN, PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

825 E PIKES PEAK AVE BEHAVIORAL HEALTH PET
COLORADO SPRINGS CO
80903-3635
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5781
  • Fax: 719-776-2313
Mailing address:
  • Phone: 719-776-8482
  • Fax: 719-776-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2548
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: