Provider Demographics
NPI:1235451592
Name:WIGGINS, DWAN (SLPA)
Entity Type:Individual
Prefix:MS
First Name:DWAN
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24306 S SHADY OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2726
Mailing Address - Country:US
Mailing Address - Phone:708-672-0954
Mailing Address - Fax:
Practice Address - Street 1:6006 W. 158TH
Practice Address - Street 2:
Practice Address - City:OAK FORREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-535-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170001622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant