Individual
MADISON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
600 3 MILE ROAD NW, STE 200, GRAND RAPIDS, MI 49544-1691
(855) 832-6727
Mailing address
1188 COBB DR SE APT 3B, GRAND RAPIDS, MI 49508-7364
(815) 575-3338
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/15/2019
Last updated
10/07/2025
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