Individual
MIRANDA M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
146 SW 134TH ST, MOORE, OK 73170-1488
(405) 265-9324
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
19109513
OK
Other
Enumeration date
01/06/2020
Last updated
12/31/2025
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