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NPI Code Detail

MEDICARE: MONICA WAGGONER

MEDICARE: MONICA WAGGONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianWA
2103K00000XBehavior Analyst1-21-49216

General Provider Information

NPI Number : 1457886301
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA WAGGONER
Provider Business Mailing Address
First Line : 8019 NE 13TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-9604
Country : US
Telephone Number : 360-713-2455
Fax Number :
Provider Business Practice Location Address
First Line : 8019 NE 13TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-9604
Country : US
Telephone Number : 360-713-2455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2017
Last Update Date : 04/19/2021

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Directions to “ MONICA WAGGONER ” Practice Location

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