Provider Demographics
NPI:1679092803
Name:WIGGS, KRISTIN ALYSE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ALYSE
Last Name:WIGGS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 LYNDALE AVE S APT 225
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2977
Mailing Address - Country:US
Mailing Address - Phone:847-280-0095
Mailing Address - Fax:
Practice Address - Street 1:825 S 8TH ST STE 600
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1209
Practice Address - Country:US
Practice Address - Phone:612-873-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist