Provider Demographics
NPI:1295877306
Name:BIGGAN, SHANNAH LYNNE (PHD)
Entity type:Individual
Prefix:
First Name:SHANNAH
Middle Name:LYNNE
Last Name:BIGGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6526
Mailing Address - Country:US
Mailing Address - Phone:520-352-9955
Mailing Address - Fax:520-352-9960
Practice Address - Street 1:7461 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-352-9955
Practice Address - Fax:833-915-0222
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3255103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ680015965OtherMEDICARE RAILROAD
AZ2351033OtherAETNA
AZ193443OtherMANAGED HEALTH NETWORK
AZ473843Medicaid
AZAZ0616070OtherBLUE CROSS BLUE SHIELD AZ
AZ473843Medicaid
AZAZ0616070OtherBLUE CROSS BLUE SHIELD AZ