Provider Demographics
NPI:1720379605
Name:WAGGONER, CYNDI (CADC II)
Entity type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:KAY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2513
Mailing Address - Country:US
Mailing Address - Phone:541-406-8647
Mailing Address - Fax:
Practice Address - Street 1:390 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2513
Practice Address - Country:US
Practice Address - Phone:541-406-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-08-58101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)