Individual
DANIEL JACOB WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
6405 OLD MAIN HILL, LOGAN, UT 84322-3511
(435) 797-3403
Mailing address
6405 OLD MAIN HILL, LOGAN, UT 84322-6405
(818) 462-1168
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
14004096-2506
UT
Other
Enumeration date
01/10/2020
Last updated
08/20/2025
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