Active NPI
Peggy Ellen Waggoner, MA
- Speech-Language Pathologist
- Kansas City, KS
National Provider Identifier
1215045612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 952
- Practice address
- 3901 Rainbow Blvd MSC 4043
2032 School of Nursing
Kansas City, KS 66160-0001 - Phone
- (866) 249-9736
- NPI assigned
- Aug 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 952 | KS | Primary |
| Speech-Language Pathologist | 235Z00000X | 107658 | MO |
Addresses
Primary practice location
3901 Rainbow Blvd MSC 4043
2032 School of Nursing
Kansas City, KS 66160-0001
Mailing address
PO Box 9418
The Woodlands, TX 77387-9418
Phone (866) 249-9736
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200365490A | Medicaid | KS | |
| 14084038 | Other | IND BCBS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 952 | KS | MD | Clinical Psychologist |
| 107658 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ku Health Partners, Inc | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243468800000",
"number": "1215045612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9418",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773879418",
"telephone_number": "866-249-9736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 RAINBOW BLVD MSC 4043",
"address_2": "2032 SCHOOL OF NURSING",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661600001",
"telephone_number": "866-249-9736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "PEGGY",
"middle_name": "ELLEN",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-26",
"last_updated": "2009-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "KS",
"license": "952",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "107658",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200365490A",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IND BCBS PROVIDER NUMBER",
"identifier": "14084038",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.