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General NPI Number Information
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NPI Number | 1083409866
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Entity Type | Individual
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Provider Name | BARRY THOMAS WAGNER PHD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1613 W RIVERSIDE AVE
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City | MUNCIE
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State | IN
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Zip | 47306-1012
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Country | US
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Telephone | 765-285-4422
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Fax | 765-285-5632
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Provider Business Mailing Address
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Address Line | 13017 OXBRIDGE PL
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City | FISHERS
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State | IN
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Zip | 46037-7227
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Country | US
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Telephone | 317-727-1963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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