| NPI | 1063274066 |
|---|---|
| Former Name | KAITLYN MADDEN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 90426) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA SCRATX90426) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2026-06-23 |