Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lyle Walter Wagner III, PHD, LP

Individual provider Clinical Psychologist · NPI 1649683939

Lyle Walter Wagner III, PHD, LP is a Clinical Psychologist in Coon Rapids, Minnesota. Licensed in Minnesota. Registered with an NPI since 2014.

Licensed in
MN
In the registry since
2014
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

3907 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2520
Phone: (320) 629-7600
Fax: (651) 925-0071
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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 5751 (MN)

Record details

NPI number1649683939
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD , LP
Sole proprietorNo
NPI enumeratedJune 4, 2014
Last updated in NPPESJune 4, 2014

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