| NPI | 1689470023 |
|---|---|
| Former Name | SHELBY WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA BACB330712) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 4557) |
| 103TS0200X Psychologist, School (Licence: CA 220108724) | |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-25 |