Individual
MRS. KATHLEEN A WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
400 N WASHINGTON ST STE 111, FARMINGTON, MO 63640-1731
(573) 664-1117
(573) 664-1117
Mailing address
RR 2 BOX 2335, SEDGEWICKVILLE, MO 63781-9706
(573) 576-1936
(573) 664-1117
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2004014231
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202194
BLUE CROSS BLUE SHIELD
MO
01
—
431344414WAG
UNITY MANAGED MENTAL HEAL
MO
05
—
499297703
—
MO
01
—
738553
HEALTHLINK
MO
Enumeration date
09/13/2006
Last updated
09/25/2019
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