Individual
EDNA WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16052 BEACH BLVD STE 215, HUNTINGTON BEACH, CA 92647-3853
(714) 916-0641
Mailing address
307 N SINGINGWOOD ST UNIT 24, ORANGE, CA 92869-3120
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP5954
CA
Other
Enumeration date
12/10/2014
Last updated
12/10/2014
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