Stacey Ketry Wagner

NPI #1013503481 in Chattanooga, Tennessee

Provider Information

NPI Number: 1013503481
Entity Type: Individual
Name: Stacey Ketry Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 18, 2020
Last Updated: Dec 18, 2020

Practice Location

Address: 2826 AMNICOLA HWY
City: Chattanooga
State: Tennessee
ZIP Code: 37406-3605
Phone: (423) 417-3273

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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