DR. JOLYNN WAGNER (PHD) – Clinical Psychologist, NPI 1093917320

DR. JOLYNN WAGNER (PHD) is a healthcare provider. based in Duvall, Washington. specializing in Clinical Psychologist. They hold the professional credentials PHD. They hold a License No. PY00002370 (WA). The NPI Number for DR. JOLYNN WAGNER (PHD) is 1093917320

Main info

Female
Sole Proprietor
29 Years Of Experience
Accepts Medicare Assignment
Name
DR. JOLYNN WAGNER (PHD)
NPI
1093917320
Phone
(425) 343-3289
Address
26502 NE VALLEY ST SUITE 101
Enumeration Date
31 May 2007
Last Update Date
21 March 2016

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2157642403
Graduation Year
1997 (29 years ago)
PAC ID
2264860568
Group Practice PAC ID
1557690351
Professional Enrollment ID
I20200320000613
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

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Provider Addresses for DR. JOLYNN WAGNER (PHD)

  • Northeast Valley Street, Duvall, King County, Washington, 98019, United States

    DUVALL, WA 98019

    Phone: (425) 343-3289

    Mailing address matches the actual address.

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.

This can happen when there are no reportable CMS Open Payments records.

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: 2020-03-20

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200320000613IClinical PsychologistDETBD

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.

Verify on CMS Revalidation Lookup Tool

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 98019)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1557690351View full group profile
NameSpecialtyState
Clinical Social WorkerDE
Clinical Social WorkerDE
Nurse PractitionerDE
Clinical Social WorkerDE
Clinical Social WorkerDE
Clinical PsychologistPA

Reviews

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Frequently asked questions

What unique ID ties claims to DR. JOLYNN WAGNER (PHD)?
NPI 1093917320 is assigned to DR. JOLYNN WAGNER (PHD) under the national enumeration system.
Does this profile mean DR. JOLYNN WAGNER (PHD) is currently active?
Yes — DR. JOLYNN WAGNER (PHD) appears active in the national provider directory.
Does DR. JOLYNN WAGNER (PHD) list a primary specialty?
If you are matching referrals, note Clinical Psychologist for DR. JOLYNN WAGNER (PHD). Clinical services aligned with this taxonomy classification.
Where is DR. JOLYNN WAGNER (PHD)'s primary listing?
We display Duvall, Washington because that is what the record indicates for DR. JOLYNN WAGNER (PHD).
What if Duvall, Washington seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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