Individual
ANGELA CATHERINE WANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, MED, BCBA, LBA
Contact information
Practice address
14733 CLAYTON RD, BALLWIN, MO 63011-2660
(314) 339-7732
Mailing address
9647 HALE DR, SAINT LOUIS, MO 63123-5521
(314) 910-1874
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2019003272
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-18-32979
BCBA CERTIFICATION
—
01
—
2019003272
BCBA STATE LICENSURE
MO
Enumeration date
02/22/2019
Last updated
02/22/2019
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