Individual
SANDRA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
1800 S 35TH ST, GALESBURG, MI 49053-9688
(269) 484-1121
Mailing address
5069 SHADYMEADOW LN APT F, KALAMAZOO, MI 49048-8290
(719) 210-5667
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001058
MI
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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