DR. JACQUELYN WRIGHT WAGNER (PSY.D.) – Clinical Psychologist, NPI 1528428398
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,110 CLINICAL PSYCHOLOGIST in MN
Provider Addresses for DR. JACQUELYN WRIGHT WAGNER (PSY.D.)
1772 Steiger Lake Ln
Suite 200
Victoria, MN 553867723
Phone: (952) 443-4600
Type: Location
Healthpartners Como, 2500, Como Avenue, Saint Paul, Ramsey County, Minnesota, 55108, United States
SAINT PAUL, MN 551081460
Phone: (651) 641-6200
Type: Location
8170 33RD AVE S # MS 21110Q
MINNEAPOLIS, MN 554254516
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-12-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20171204002182 | I | Clinical Psychologist | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55386)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Clinical Psychologist | MN | |
| - | MN | |
| P S Y C H I A T R Y | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| P O D I A T R Y | MN | |
| Physician Assistant | MN | |
| Physician Assistant | MN |
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