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General NPI Number Information
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NPI Number | 1164233003
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Entity Type | Individual
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Provider Name | TREVOR WAAGEN PH.D., LP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 501 N COLUMBIA RD RM 1300
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City | GRAND FORKS
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State | ND
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Zip | 58203-2817
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Country | US
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Telephone | 701-777-3745
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 30TH AVE S APT 103
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City | GRAND FORKS
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State | ND
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Zip | 58201-5952
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Country | US
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Telephone | 406-478-3190
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 655
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License Number State | ND
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