Individual
EMILY HAZEL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5847 NE 122ND AVE STE 200, PORTLAND, OR 97230-1079
(971) 339-7040
Mailing address
2525 NE MULTNOMAH ST, PORTLAND, OR 97232-2127
(714) 949-0735
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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