Provider Demographics
NPI:1568023042
Name:WIGGINS, KATHY MACHELLE
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MACHELLE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3202
Mailing Address - Country:US
Mailing Address - Phone:336-314-7105
Mailing Address - Fax:803-753-9196
Practice Address - Street 1:314 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3202
Practice Address - Country:US
Practice Address - Phone:336-314-7105
Practice Address - Fax:803-753-9196
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician