Provider Demographics
NPI:1568556009
Name:WIGER, DONALD E (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
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 1:360 N ROBERT ST #317
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101
Mailing Address - Country:US
Mailing Address - Phone:651-983-0383
Mailing Address - Fax:651-337-0084
Practice Address - Street 1:360 N ROBERT ST #317
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-983-0383
Practice Address - Fax:651-337-0084
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-19333OtherMEDICA
MN990991946897OtherPREFERREDONE
MN108690OtherUCARE
MN45Q81WIOtherBLUE CROSS/BLUE SHIELD
MN411891484 39069OtherHEALTH PARTNERS