Individual
MIRANDA M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15809 NE 23RD ST, CHOCTAW, OK 73020-8428
(405) 281-1040
Mailing address
3903 N HARRISON ST, SHAWNEE, OK 74804-1426
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
19109513
OK
Other
Enumeration date
01/06/2020
Last updated
07/17/2026
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