Individual provider · Type 1 NPI

Mary Rose Waggoner, QMHA

Peer Specialist · Roseburg, OR

NPI number 1083979264 Active

Practice location

621 W Madrone St
Roseburg, OR 97470-3090

Call (541) 440-3532 Map

Fax (541) 440-3554

Mailing address

PO Box 1121
Roseburg, OR 97470-0254

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XNone listed
Community Health Worker 172V00000XNone listed
Peer Specialist Primary 175T00000XNone listed

Peer Specialist: Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

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About NPI 1083979264

Mary Rose Waggoner, QMHA's National Provider Identifier is 1083979264, issued on Jul 12, 2012. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Roseburg, OR. The record was last updated on Feb 14, 2022.