Provider Demographics
NPI:1356613103
Name:WIGGAM, JULIE A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WIGGAM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:BRIZIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2730
Mailing Address - Country:US
Mailing Address - Phone:317-736-3510
Mailing Address - Fax:317-346-3727
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2730
Practice Address - Country:US
Practice Address - Phone:317-736-3510
Practice Address - Fax:317-346-3727
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003728A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269800Medicaid