Provider Demographics
NPI:1508009259
Name:WIGGINS, SHANA LEIGH (BA, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LEIGH
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W NASH ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5512
Mailing Address - Country:US
Mailing Address - Phone:817-424-9797
Mailing Address - Fax:817-424-9792
Practice Address - Street 1:400 E ROYAL LN STE 290
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3602
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:726-759-1007
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0062149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst