Angela Catherine Wanta, LMSW, MED, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

2019003272 Issued in MO

Practice address

14733 Clayton Rd
Ballwin, MO 63011-2660

Phone

(314) 339-7732

NPI assigned

Feb 22, 2019

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 identifiers 2

Other names 1

• Angela Catherine Pullam Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

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.

• Autism and Behavioral Spectrum LLC

  • Clinic/Center
  • Chesterfield, MO
  • NPI 1780131300
  NPD (past)

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

{
    "created_epoch": "1550793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1932666211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9647 HALE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631235521",
            "telephone_number": "314-910-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14733 CLAYTON RD",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112660",
            "telephone_number": "314-339-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANTA",
        "first_name": "ANGELA",
        "middle_name": "CATHERINE",
        "credential": "LMSW, MED, BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-22",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MO",
            "license": "2019003272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA STATE LICENSURE",
            "identifier": "2019003272",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA CERTIFICATION",
            "identifier": "1-18-32979",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "PULLAM",
            "middle_name": "CATHERINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walgreen Co
• Walgreen Co
• Walgreen Co
• Walters Chiropractic LLC
• Joseph Walters
• Jason Garrett Watts, PHARM.D.
• WCCC Op LLC
• Michael Joe Webb, LMT
• Michael Patrick Weber, D.M.D., P.C.
• Sarah Wedick

• Behavior Analyst in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Behavior Analyst in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; 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.