Individual
GARRETT WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
6925 BURROBACK AVE, COLORADO SPRINGS, CO 80911-2901
(719) 466-3869
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-206195
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790211605
—
CO
Enumeration date
03/08/2022
Last updated
02/06/2023
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