Provider Demographics
NPI:1801000344
Name:WIGERT, LEE R (MA, DMIN, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:R
Last Name:WIGERT
Suffix:
Gender:M
Credentials:MA, DMIN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N. SHORE DR.
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2527
Mailing Address - Country:US
Mailing Address - Phone:402-463-4722
Mailing Address - Fax:402-461-7463
Practice Address - Street 1:710 N TURNER AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7621
Practice Address - Country:US
Practice Address - Phone:402-463-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE354101YM0800X
NE416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84075OtherBCBS PREFERRED PROVIDER