| Doctor Name: | KATHLEEN WAGGONER |
| NPI Number: | 1609971886 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 2004014231 |
| Business Practice Address: | Rural Route 2 Box 2335 Sedgewickville, MO - 63781 |
| Business Phone Number: | 5738660046 |
| Business Fax Number: | 5738662556 |
| Mailing Address: | Rr 2 Box 2335, SEDGEWICKVILLE |
| State: | MO |
| Postal Code: | 637819706 |
| Phone Number: | 5738660046 |
| Fax Number: | 5738662556 |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 02/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2004014231 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |