Wagner, Kassidy Diane
Wagner, Kassidy Diane is an individual health care provider with primary practice located at 449 S Fitness Pl , Eagle ID 83616-6828. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Wagner, Kassidy Diane can be contacted via phone (208) 957-6301.Contact Information
Primary practice address
449 S Fitness Pl
Eagle ID 83616-6828
Phone: (208) 957-6301
Fax: (208) 228-0585
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | 1-23-68300 | Idaho |
Profile Details
| NPI number | 1376197723 |
|---|---|
| LBN Legal business name | Wagner, Kassidy Diane |
| Credentials | BCBA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 24th, 2019 |
| Last updated | Dec 21st, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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