Jennifer Renee Waggoner

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

3360 Issued in IL

Practice address

427 W Orchard St Ste D
Vandalia, IL 62471-1256

Phone

(618) 322-4491

NPI assigned

Jun 14, 2019

Last updated

Jun 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1427618289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 WASHINGTON AVE S",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443405",
            "telephone_number": "460-295-2947",
            "fax_number": "163-750-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W ORCHARD ST STE D",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711256",
            "telephone_number": "618-322-4491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "IL",
            "license": "3360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vandalia Hco, LLC (Vandalia Rehabilitation & Health Care Center)
• Vandalia Hco, LLC
• Vandalia Healthcare & Senior Living LLC
• Vandalia Physical Therapy LTD (Transforming Physical Therapy)
• Vandalia Terrace, LTD
• Wal-Mart Stores, Inc (Vision Center 30-0317)
• Walmart Inc.
• WC- Vandalia Ops, LLC (Brookstone Estates of Vandalia)
• Matthew Edward Weems, FNP-C
• Jordan Weis, D.M.D.

• Hearing Instrument Specialist in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Hearing Instrument Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.