Landyn L Bagwell

Individual provider Active NPI Behavior Technician · Mt Juliet, TN

NPI 1083476584 · NPPES record last updated Jan 29, 2024

Key facts

NPI
1083476584
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
1535 N Mount Juliet Rd
Mt Juliet, TN 37122-3315
Phone
(615) 560-6622
NPI assigned
Jan 29, 2024
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

1535 N Mount Juliet Rd
Mt Juliet, TN 37122-3315

Mailing address

630 Providence Pkwy Apt 3213
Mt Juliet, TN 37122-2675
Phone (270) 994-1945

Other providers in Mt Juliet, TN

All providers in Mt Juliet, TN · Behavior Technician in Tennessee

Sources for this page

Verify at the official NPI Registry.