Individual
ELLIETTE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29875 W 339TH ST, OSAWATOMIE, KS 66064-4159
(913) 755-4357
Mailing address
29875 W 339TH ST, OSAWATOMIE, KS 66064-4159
(913) 755-4357
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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