Individual
PAIGE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16205 NW BETHANY CT STE 116, BEAVERTON, OR 97006-4687
(503) 860-6525
Mailing address
5511 SW MULTNOMAH BLVD, PORTLAND, OR 97219-3269
(914) 557-5383
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
10219156
OR
Other
Enumeration date
02/01/2017
Last updated
02/04/2022
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