Provider Demographics
NPI:1760648604
Name:WAUGH, DEANNA AILEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:AILEEN
Last Name:WAUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6242
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-6242
Mailing Address - Country:US
Mailing Address - Phone:808-554-9507
Mailing Address - Fax:
Practice Address - Street 1:2141 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3065
Practice Address - Country:US
Practice Address - Phone:559-856-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7073101YM0800X
HI1984103T00000X
CAPSY31184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health