Provider Demographics
NPI:1194043877
Name:WAGGONER, APRIL RAE (MA MFT)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:RAE
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3402
Mailing Address - Country:US
Mailing Address - Phone:360-567-0479
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3402
Practice Address - Country:US
Practice Address - Phone:360-567-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist