Individual
SHARON WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
348 W 79TH ST, SHREVEPORT, LA 71106-4820
(318) 688-8190
Mailing address
348 W 79TH ST, SHREVEPORT, LA 71106-4820
(318) 688-8190
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6727
LA
Other
Enumeration date
10/31/2015
Last updated
10/31/2015
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