Provider Demographics
NPI:1134317340
Name:HUNT WIGGINS, SHIRLEY (RA SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:HUNT WIGGINS
Suffix:
Gender:F
Credentials:RA SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 COMMERCENTER W
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3333
Mailing Address - Country:US
Mailing Address - Phone:909-386-0335
Mailing Address - Fax:909-890-4018
Practice Address - Street 1:7541 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3711
Practice Address - Country:US
Practice Address - Phone:909-425-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical