Provider Demographics
NPI:1235893991
Name:WAGGONER, HANNAH SUE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:SUE
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CULLUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4534
Mailing Address - Country:US
Mailing Address - Phone:907-750-8641
Mailing Address - Fax:
Practice Address - Street 1:208 CULLUM AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4534
Practice Address - Country:US
Practice Address - Phone:907-750-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health