| Doctor Name: | EDNA WAGGONER |
| NPI Number: | 1972901742 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | SP5954 |
| Business Practice Address: | 16052 Beach Blvd Ste 215 Huntington Beach, CA - 926473853 |
| Business Phone Number: | 7149160641 |
| Business Fax Number: | |
| Mailing Address: | 307 N Singingwood St Unit 24, ORANGE |
| State: | CA |
| Postal Code: | 928693120 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/10/2014 |
| NPI Last Update Date: | 12/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP5954 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |