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MARY ROSE WAGGONER QMHA
NPI 1083979264
Peer Specialist in Roseburg, OR

Active since July 12, 2012
621 W MADRONE ST, ROSEBURG, OR 97470(541) 440-3532(541) 440-3554 Get Directions Write a Review

NPPES record last updated: February 14, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 14, 2022, Oct 27, 2016 (2 updates tracked since 2016).

About Mary Rose Waggoner Qmha NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY ROSE WAGGONER QMHA (NPI 1083979264) is an individual peer specialist in Roseburg, Oregon and active in the NPI registry since July 2012.

NPPES Registry Identity

NPI1083979264
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameMARY ROSE WAGGONERCredential: QMHA
Location Address621 W MADRONE STRoseburg, OR 97470-3090
Mailing AddressPo Box 1121Roseburg, OR 97470-0254 · (541) 672-2691
Phone(541) 440-3532
Fax(541) 440-3554
Sole ProprietorNo
Enumeration DateJuly 12, 2012
Last NPPES UpdateFebruary 14, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2022
✔ NPI 1083979264 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
Definition
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.
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
Also ListedCommunity Health WorkerTaxonomy 172V00000X
621 W MADRONE ST, Roseburg, OR 97470
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Other Names 1

Other Name (5)Mary Rose Koerner

Other Identifiers 1

Medicaid500663428OR

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM F SHOBE JR. LMFT
Marriage & Family Therapist
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 492-4550
HEATHER IRENE JOHNSON MSW
Social Worker
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 440-3532
URIAH HEATH YRAGUEN
Peer Specialist
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 672-2691
MR. DALE EDWARD WILLIAMS MC, LPC
Counselor (Mental Health)
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 440-3532
EMILY TUCKER LPC NCC
Counselor (Professional)
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 672-2691
INGER C BOYD MA ED., BS
Counselor
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 440-3532
MAE L HOOPES
Counselor (Addiction (Substance Use Disorder))
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 672-2691
JENNIFER DIANE LOWRY
Counselor (Mental Health)
621 W MADRONE ST
ROSEBURG, OR 97470
Douglas County (541) 440-3532

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Waggoner's NPI number?

The NPI number for Mary Waggoner is 1083979264. It was assigned to this individual provider in the NPPES registry on July 12, 2012. The provider is also known as Mary Rose Koerner.

Where is Mary Waggoner located?

Mary Waggoner practices at 621 W Madrone St, Roseburg, OR 97470. The listed phone number is (541) 440-3532.

What is Mary Waggoner's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Mary Waggoner was last updated on February 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.