IndividualActive
Glavis Wagner
NPI 1720587553 · Prevention Professional · Pendleton, OR
Provider details
- NPI number
- 1720587553
- Entity type
- Individual
- Primary specialty
- Prevention ProfessionalOther Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 17-CRM-217 (OR)
Specialties & taxonomies
Other Service Providers
Behavioral Health & Social Service Providers
Other Service Providers
Practice location
46314 Timine Way
Pendleton, OR 97801
Phone: (541) 966-9830
Approximate (ZIP-level) locationGet directions
Mailing address
46314 Timine Way
Pendleton, OR 97801-9417
Registry dates
- Enumerated
- 2018-02-07
- Last updated
- 2020-07-23
- Certified
- 2020-07-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.