LYLE WALTER WAGNER III PHD, LP
NPI 1649683939
Psychologist - Clinical in Coon Rapids, MN

Q: What is Lyle Wagner's NPI number?

The NPI number for Lyle Wagner is 1649683939. It was assigned to this individual provider in the NPPES registry on June 4, 2014.

Q: What is Lyle Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Lyle Wagner was last updated on June 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 04, 2014

3907 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433(320) 629-7600(651) 925-0071 Get Directions Write a Review

NPPES record last updated: June 4, 2014. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Lyle Walter Wagner Iii Phd, Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LYLE WALTER WAGNER III PHD, LP (NPI 1649683939) is an individual clinical provider in Coon Rapids, Minnesota, licensed in Minnesota (5751) and active in the NPI registry since June 2014.

NPPES Registry Identity

NPI1649683939

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameLYLE WALTER WAGNER IIICredential: PHD, LP

Location Address3907 COON RAPIDS BLVD NWCoon Rapids, MN 55433-2520

Mailing Address220 Railroad St SePine City, MN 55063-1540 · (320) 629-7600 · Fax (651) 925-0071

Phone(320) 629-7600

Fax(651) 925-0071

Sole ProprietorNo

Enumeration DateJune 4, 2014

✔ NPI 1649683939 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MN · 5751

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3907 COON RAPIDS BLVD NW, Coon Rapids, MN 55433

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lyle Wagner's NPI number?

The NPI number for Lyle Wagner is 1649683939. It was assigned to this individual provider in the NPPES registry on June 4, 2014.

Where is Lyle Wagner located?

Lyle Wagner practices at 3907 Coon Rapids Blvd NW, Coon Rapids, MN 55433. The listed phone number is (320) 629-7600.

What is Lyle Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Lyle Wagner was last updated on June 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.