Provider Demographics
NPI:1336896695
Name:WIGREN, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:WIGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2527
Mailing Address - Country:US
Mailing Address - Phone:989-400-1562
Mailing Address - Fax:
Practice Address - Street 1:201 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2527
Practice Address - Country:US
Practice Address - Phone:989-400-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional