MEDICARE: ALLISON WAGNER BCBA

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	103K00000X	Behavior Analyst	301090	KY

General Provider Information

NPI Number	:	1942920491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON WAGNER BCBA

Provider Business Mailing Address
First Line	:	2357 HUGUENARD DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3015
Country	:	US
Telephone Number	:	859-436-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 HUGUENARD DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3015
Country	:	US
Telephone Number	:	859-436-8585
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	02/10/2026

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