Waggoner Behavioral Health LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

WAGGONER BEHAVIORAL HEALTH LLC

Practice address

489 Tanglewood Dr
Gurnee, IL 60031-3431

Phone

(224) 410-1239

NPI assigned

Nov 26, 2021

Last updated

Nov 26, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rockelle Waggoner, BCBANPI 1881174720

Title

Owner

Phone

(224) 410-1239

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rockelle Waggoner

  • Behavior Analyst
  • Gurnee, IL
  • NPI 1881174720
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637884800000",
    "number": "1407513393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 TANGLEWOOD DR",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313431",
            "telephone_number": "224-410-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 TANGLEWOOD DR",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313431",
            "telephone_number": "224-410-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGGONER BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-26",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "ROCKELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-410-1239",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mihaela Vladu, APRN, PMHNP-BC
• Yelena Voloshin, DPT
• Susan Vonbruenchenhein
• Emily Christine Vook, PA-C
• Danny Khai Vu, M.D.
• Kelsey Waggoner
• Rockelle Waggoner
• Peter Joseph Waidzunas, D.D.S.
• Cynthia A Wait, M.D.
• Walgreen Co (Walgreens #04097)

• Behavior Analyst in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.