Sandra Wagner, MA, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

7401001058 Issued in MI

Practice address

1800 S 35TH St
Galesburg, MI 49053-9688

Phone

(269) 484-1121

NPI assigned

May 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Sandra Garcia Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1770106072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5069 SHADYMEADOW LN APT F",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490488290",
            "telephone_number": "719-210-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 S 35TH ST",
            "city": "GALESBURG",
            "state": "MI",
            "postal_code": "490539688",
            "telephone_number": "269-484-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SANDRA",
        "credential": "MA, BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-20",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401001058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "GARCIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Alexandra Christine Williams

• Behavior Analyst in Galesburg, MI
• Providers in Galesburg, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.