Provider Demographics
NPI:1073786570
Name:SIGUT, WALTER J
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:SIGUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4236
Mailing Address - Country:US
Mailing Address - Phone:724-430-0555
Mailing Address - Fax:724-430-0966
Practice Address - Street 1:99 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4236
Practice Address - Country:US
Practice Address - Phone:724-430-0555
Practice Address - Fax:724-430-0966
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001427L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016247990001Medicaid
PAPS001427LOtherPSYCHOLOGIST