Individual
MRS. BRENNA LYN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSC, BCBA, LBA
Contact information
Practice address
88 E 1000 N, TOOELE, UT 84074-9693
(435) 249-0934
Mailing address
1311 COUNTRY LN, ERDA, UT 84074-9799
(435) 840-8166
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
11353635-2507
UT
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/26/2018
Last updated
11/28/2022
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