Individual
PEGGY ELLEN WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
3901 RAINBOW BLVD MSC 4043, 2032 SCHOOL OF NURSING, KANSAS CITY, KS 66160-0001
(866) 249-9736
Mailing address
PO BOX 9418, THE WOODLANDS, TX 77387-9418
(866) 249-9736
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
107658
MO
235Z00000X
Speech-Language Pathologist
Primary
952
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14084038
IND BCBS PROVIDER NUMBER
—
05
—
200365490A
—
KS
Enumeration date
08/26/2006
Last updated
05/28/2009
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