Individual
JOSHUA WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6200 SW ARCTIC DR, BEAVERTON, OR 97005-9447
(458) 256-0719
Mailing address
6200 SW ARCTIC DR, BEAVERTON, OR 97005-9447
(458) 256-0719
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10240604
OR
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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