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General NPI Number Information
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NPI Number | 1285138628
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH WAGNER M.S., BCBA, LBS
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Gender | Female
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 3424 WILLIAM PENN HWY STE 215
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City | PITTSBURGH
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State | PA
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Zip | 15235-5444
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Country | US
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Telephone | 440-242-9182
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Fax |
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Provider Business Mailing Address
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Address Line | 640 FREEDOM BUSINESS CTR DR STE 220
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1376
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Country | US
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Telephone | 440-242-9182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BH006342
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License Number State | PA
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