Individual
SHANNON LEE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 UNION ST, MANCHESTER, CT 06042-1938
(860) 455-3629
Mailing address
203 UNION ST, MANCHESTER, CT 06042-1938
(860) 455-3629
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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