MEDICARE: LAUREN ELIZABETH WAGNER M.S., BCBA, LBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	103K00000X	Behavior Analyst	BH006342	PA

General Provider Information

NPI Number	:	1285138628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELIZABETH WAGNER M.S., BCBA, LBS

Provider Business Mailing Address
First Line	:	640 FREEDOM BUSINESS CTR DR STE 220
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-1376
Country	:	US
Telephone Number	:	440-242-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 WILLIAM PENN HWY STE 215
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5444
Country	:	US
Telephone Number	:	440-242-9182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	08/09/2023

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