Provider Demographics
NPI:1154600310
Name:WAGGONER, BRYNN WENDY (SLP)
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:WENDY
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 WINDCREST DR APT 2627
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3024
Mailing Address - Country:US
Mailing Address - Phone:512-773-9470
Mailing Address - Fax:
Practice Address - Street 1:4409 HELSTON DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3748
Practice Address - Country:US
Practice Address - Phone:972-584-0284
Practice Address - Fax:866-323-1955
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist