Individual
TRACY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SCMT, MT-BC
Contact information
Practice address
831 W 2550 S, NIBLEY, UT 84321-6381
(435) 890-0885
Mailing address
831 W 2550 S, NIBLEY, UT 84321-6381
(435) 890-0885
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
9203190-4010
UT
Other
Enumeration date
10/05/2015
Last updated
10/05/2015
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