Individual
MR. KENNETH RAY WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LADC
Contact information
Practice address
4301 MOW-WAY ROAD, FORT SILL, OK 73503-6300
(580) 458-2134
Mailing address
2103 NW 55TH ST, LAWTON, OK 73505-3117
(580) 248-5425
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
415
OK
Other
Enumeration date
11/13/2006
Last updated
07/08/2007
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