Individual
MRS. TARA LEE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
5099 CAMEO TER, PERRY HALL, MD 21128-8934
(410) 967-3439
(410) 785-3848
Mailing address
5099 CAMEO TER, PERRY HALL, MD 21128-8934
(410) 967-3439
(410) 785-3848
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/18/2010
Last updated
03/18/2010
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