Provider Demographics
NPI:1114404001
Name:WIGGANS, BRIANA ELISE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:ELISE
Last Name:WIGGANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 E EL PARQUE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2902
Mailing Address - Country:US
Mailing Address - Phone:520-437-8385
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST STE 125A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3456
Practice Address - Country:US
Practice Address - Phone:602-224-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA113142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant