Provider Demographics
NPI:1508491044
Name:WAGNER, ASHLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 LANDERBROOK DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4031
Mailing Address - Country:US
Mailing Address - Phone:216-446-2944
Mailing Address - Fax:315-306-3610
Practice Address - Street 1:5885 LANDERBROOK DR STE 310
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4031
Practice Address - Country:US
Practice Address - Phone:216-446-2944
Practice Address - Fax:315-306-3610
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19-105958106S00000X
OH01197103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician