Provider Demographics
NPI:1194826669
Name:WIGER, KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:WIGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 DENALI ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2738
Mailing Address - Country:US
Mailing Address - Phone:907-277-3926
Mailing Address - Fax:907-677-9551
Practice Address - Street 1:2605 DENALI ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2738
Practice Address - Country:US
Practice Address - Phone:907-277-3926
Practice Address - Fax:907-677-9551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA298103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS0298Medicaid
AKPS0298Medicaid