Provider Demographics
NPI:1114497427
Name:WIGGINS, CYNTHIA JUNE (MSW,PLMHP, PLCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JUNE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MSW,PLMHP, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3106
Mailing Address - Country:US
Mailing Address - Phone:308-635-1488
Mailing Address - Fax:308-635-7880
Practice Address - Street 1:1509 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3106
Practice Address - Country:US
Practice Address - Phone:308-635-1488
Practice Address - Fax:308-635-7880
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NE73151041C0700X
NE11701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical