Doctor Name: | BRITTTANY WAGGONER |
NPI Number: | 1518246859 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 4116576 |
Business Practice Address: | 1288 N Tapadero Dr Apt C Dewey, AZ - 863275823 |
Business Phone Number: | 9284998069 |
Business Fax Number: | |
Mailing Address: | 1288 N Tapadero Dr Apt C, DEWEY |
State: | AZ |
Postal Code: | 863275823 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/04/2011 |
NPI Last Update Date: | 08/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 4116576 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |