Individual
REGINNA L WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
76 CHAMPAGNE DR, MORGANTOWN, WV 26508-5223
(304) 692-1820
Mailing address
76 CHAMPAGNE DR, MORGANTOWN, WV 26508-5223
(304) 692-1820
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-10533
WV
Other
Enumeration date
03/10/2017
Last updated
03/10/2017
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