Individual
CASSONDRA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43636 KALIFORNSKY BEACH RD, SOLDOTNA, AK 99669-8264
(907) 931-5548
Mailing address
PO BOX 771324, EAGLE RIVER, AK 99577-1324
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
22-245484
AK
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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