Provider Demographics
NPI:1588182075
Name:WAGGONER, BARBARA JOYCE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOYCE
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 1:6355 GUILFORD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-7108
Mailing Address - Country:US
Mailing Address - Phone:817-925-0451
Mailing Address - Fax:817-531-8375
Practice Address - Street 1:6355 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-7108
Practice Address - Country:US
Practice Address - Phone:817-925-0451
Practice Address - Fax:817-531-8375
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist