Search › Minnesota › 103TC0700X
Lyle Wagner, PHD, LP
NPI 1649683939 · on the registry since 2014
Practice
- Address
- 3907 Coon Rapids Blvd Nw
Coon Rapids, MN 55433 - Phone
- (320) 629-7600
- Fax
- (651) 925-0071
Registry record
- Primary taxonomy
- 103TC0700X
103TC0700X
- Licence states on file
- MN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2014-06-04
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota