Individual
MRS. NANCY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3605 W PIONEER PKWY, SUITE C, PANTEGO, TX 76013-4598
(817) 277-8870
(817) 277-8875
Mailing address
PO BOX 14597, ARLINGTON, TX 76094-1597
(817) 277-8870
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-07-3398
TX
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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