Whalio Doctors

NPI 1720587553

Glavis M Wagner

Practitioner Prevention Professional Pendleton, OR

Practice location

Address
46314 Timine Way, Pendleton, OR 97801
Phone
(541) 966-9830
Mailing address
46314 Timine Way, Pendleton, OR 97801-9417

Registered specialties (3)

Prevention Professional Primary
Other Service Providers Taxonomy 405300000X Licence 17-CRM-217 (OR)
Addiction (Substance Use Disorder) Counselor
Behavioral Health & Social Service Providers Taxonomy 101YA0400X Licence 17-CRM-217 (OR)
Peer Specialist
Other Service Providers Taxonomy 175T00000X Licence THW000002415 (OR)

Registry record

NPI
1720587553
Entity type
Individual
Sex (as registered)
Male
NPI issued
7 Feb 2018
Record last updated
23 Jul 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.