Provider Demographics
NPI:1346211570
Name:WIGGIN, NEURINE ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NEURINE
Middle Name:ELAINE
Last Name:WIGGIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1656
Mailing Address - Country:US
Mailing Address - Phone:847-835-2738
Mailing Address - Fax:847-835-2738
Practice Address - Street 1:673 BLUFF ST
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1656
Practice Address - Country:US
Practice Address - Phone:847-835-2738
Practice Address - Fax:847-835-2738
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01608133OtherBLUE CROSS/BLUE SHIELD
IL394470Medicare ID - Type UnspecifiedMEDICARE PART B