Provider Demographics
NPI:1578867156
Name:WIGGIN, DAWN ELIZABETH (MA, LADC)
Entity Type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:ELIZABETH
Last Name:WIGGIN
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:ELIZABETH
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LADC
Mailing Address - Street 1:3027 MIDDLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLEE
Mailing Address - State:VT
Mailing Address - Zip Code:05045-4411
Mailing Address - Country:US
Mailing Address - Phone:802-333-3649
Mailing Address - Fax:
Practice Address - Street 1:3027 MIDDLEBROOK RD
Practice Address - Street 2:
Practice Address - City:FAIRLEE
Practice Address - State:VT
Practice Address - Zip Code:05045-4411
Practice Address - Country:US
Practice Address - Phone:802-333-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)