Individual
BETHANY JANE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 W RAMSEY ST, DAWSON SPRINGS, KY 42408-1739
(813) 227-0797
Mailing address
5865 STATE ROUTE 464, MAYFIELD, KY 42066-4551
(270) 705-0314
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
277629
KY
235Z00000X
Speech-Language Pathologist
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—
Other
Enumeration date
05/10/2022
Last updated
05/17/2022
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