Brenna Lyn Wagner, MSC, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

88 E 1000 N
Tooele, UT 84074-9693

Phone

(435) 249-0934

NPI assigned

Sep 26, 2018

Last updated

Nov 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Behave, Educate, and Engage LLC

  • Behavior Analyst
  • Tooele, UT
  • NPI 1164132411
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1043795040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 COUNTRY LN",
            "city": "ERDA",
            "state": "UT",
            "postal_code": "840749799",
            "telephone_number": "435-840-8166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 E 1000 N",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840749693",
            "telephone_number": "435-249-0934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 S 700 E Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841022855",
            "country_code": "US",
            "telephone_number": "801-935-4171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1311 Country Ln",
            "address_purpose": "LOCATION",
            "city": "Erda",
            "state": "UT",
            "postal_code": "840749799",
            "country_code": "US",
            "telephone_number": "435-840-8166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1363 Country Ln",
            "address_purpose": "LOCATION",
            "city": "Erda",
            "state": "UT",
            "postal_code": "840749799",
            "country_code": "US",
            "telephone_number": "435-840-8166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRENNA",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "MSC, BCBA, LBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-26",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "UT",
            "license": "11353635-2507",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Tooele, UT
• Providers in Tooele, UT by specialty
• Behavior Analyst in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.