Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Michael Dale Wagner, PHD

Individual provider Clinical Child & Adolescent Psychologist · NPI 1760577340

Dr. Michael Dale Wagner, PHD is a Clinical Child & Adolescent Psychologist in Westerville, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2006
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

5415 Medallion Dr W
Westerville, OH 43082-9194
Phone: (614) 218-8769
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 4636 (OH)
Clinical Child & Adolescent Psychologist Taxonomy 103TC2200X · Licence 4636 (OH)

Record details

NPI number1760577340
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedOctober 3, 2006
Last updated in NPPESJune 20, 2020
Certification dateJune 20, 2020
Mailing address5415 Medallion Dr W, Westerville, OH 43082-9194

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