Waggoner, Mary Rose

Waggoner, Mary Rose is an individual health care provider with primary practice located at 621 W Madrone St , Roseburg OR 97470-3090. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Community Health Worker, Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is her primary health care specialty. Waggoner, Mary Rose can be contacted via phone (541) 440-3532.

Contact Information

Primary practice address
621 W Madrone St Roseburg OR 97470-3090
Phone: (541) 440-3532
Fax: (541) 440-3554
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Community Health Worker 172V00000X
Other Service Providers / Peer Specialist 175T00000X

Profile Details

NPI number 1083979264
LBN Legal business name Waggoner, Mary Rose
Credentials QMHA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2012
Last updated Feb 14th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083979264 NPPES
Oregon MEDICAID 500663428

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