Tara Wagner

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

25-468961 Issued in WY

Practice address

1575 N 4TH St Ste 105
Laramie, WY 82072-2091

Phone

(307) 212-3284

NPI assigned

Sep 5, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Peak Behavioral Services, LLC

  • Behavior Technician
  • Laramie, WY
  • NPI 1225866528
  NPD

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

{
    "created_epoch": "1757030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1891675211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 N 9TH ST LOT A107",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820721608",
            "telephone_number": "307-212-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 N 4TH ST STE 105",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820722091",
            "telephone_number": "307-212-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-05",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WY",
            "license": "25-468961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Volunteers of America Northern Rockies
• Volunteers of America Northern Rockies
• Volunteers of America Northern Rockies
• Ellare P. Votruba
• Alexandra J Wadsworth
• Julianna Wakamatsu
• Kiffany Wake
• Wal-Mart Stores, Inc.
• Jason Wales
• Walgreen Co

• Behavior Technician in Laramie, WY
• Providers in Laramie, WY by specialty
• Behavior Technician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; 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.