| Waggoner Behavioral Health Llc | |
|
489 Tanglewood Dr Gurnee IL 60031-3431 | |
| (224) 410-1239 | |
| Not Available |
| Full Name | Waggoner Behavioral Health Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 489 Tanglewood Dr, Gurnee, Illinois |
| Authorized Official Name and Position | Rockelle Waggoner (OWNER) |
| Authorized Official Contact | 2244101239 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Waggoner Behavioral Health Llc 489 Tanglewood Dr Gurnee IL 60031-3431 Ph: (224) 410-1239 | Waggoner Behavioral Health Llc 489 Tanglewood Dr Gurnee IL 60031-3431 Ph: (224) 410-1239 |
| NPI Number | 1407513393 |
|---|---|
| Provider Enumeration Date | 11/26/2021 |
| Last Update Date | 11/26/2021 |
| Certification Date | 11/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407513393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
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