Individual
ELIZABETH CLAIR WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8815 S TACOMA WAY STE 122, LAKEWOOD, WA 98499-7011
(206) 388-0544
Mailing address
8915 WILKENSEN RD SE TRLR 7B, YELM, WA 98597-9782
(505) 419-7118
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/21/2019
Last updated
11/21/2019
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