Active NPI
Keith A Waggoner, LSW
- Social Worker
- Wooster, OH
National Provider Identifier
1780122432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1502449
- Practice address
- 2587 Back Orrville Rd
Wooster, OH 44691-9523 - Phone
- (330) 264-9597
- Fax
- (330) 264-0946
- NPI assigned
- Feb 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1502449 | OH | Primary |
Addresses
Primary practice location
2587 Back Orrville Rd
Wooster, OH 44691-9523
Mailing address
2587 Back Orrville Rd
Wooster, OH 44691-9523
Phone (330) 264-9597
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1502449 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anazao Community Partners | Past | Accepting new patients | |
| Anazao Community Partners | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Wooster, OH
- NPI 1073873923
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Wooster, OH
- NPI 1164471082
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485993600000",
"number": "1780122432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2587 BACK ORRVILLE RD",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446919523",
"telephone_number": "330-264-9597",
"fax_number": "330-264-0946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2587 BACK ORRVILLE RD",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446919523",
"telephone_number": "330-264-9597",
"fax_number": "330-264-0946"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "KEITH",
"middle_name": "A",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-02",
"last_updated": "2017-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1502449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wooster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.