Provider Demographics
NPI:1306006390
Name:WAGGENER, LLOYD DENTON (MS)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:DENTON
Last Name:WAGGENER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 NE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4602
Mailing Address - Country:US
Mailing Address - Phone:816-524-8018
Mailing Address - Fax:816-524-8049
Practice Address - Street 1:1166 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4602
Practice Address - Country:US
Practice Address - Phone:816-524-8018
Practice Address - Fax:816-524-8049
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1424237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter