Provider Demographics
NPI:1972378933
Name:WIGGINS, SARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S WATER TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6589
Mailing Address - Country:US
Mailing Address - Phone:618-214-8201
Mailing Address - Fax:
Practice Address - Street 1:3600 S WATER TOWER PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6589
Practice Address - Country:US
Practice Address - Phone:618-244-0212
Practice Address - Fax:618-244-0535
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490260141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical