Individual
ASHLEY NICOLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
5915 S EMERSON AVE STE 100, INDIANAPOLIS, IN 46237-1972
(317) 567-9307
Mailing address
5927 RIVA RIDGE DR, INDIANAPOLIS, IN 46237-2116
(317) 519-8730
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-64329
IN
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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