Jackson Lee Wagus

NPI #1639753452 in Sandy Spring, Maryland

Provider Information

NPI Number: 1639753452
Entity Type: Individual
Name: Jackson Lee Wagus
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: May 7, 2021
Last Updated: May 7, 2021

Practice Location

Address: 17810 MEETING HOUSE RD STE 100
City: Sandy Spring
State: Maryland
ZIP Code: 20860-1039
Phone: (240) 342-2666

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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