Individual
GERALD WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
9378 OLIVE BLVD STE 317, SAINT LOUIS, MO 63132-3224
(314) 994-9344
(314) 994-3007
Mailing address
9378 OLIVE BLVD STE 317, SAINT LOUIS, MO 63132-3224
(314) 994-9344
(314) 994-3007
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001573
MO
Other
Enumeration date
10/11/2017
Last updated
10/11/2017
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