Provider Demographics
NPI:1740342419
Name:WIGTON, GRETCHEN S (LCSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:S
Last Name:WIGTON
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 1:74-5037 HANAHANAI LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1538
Mailing Address - Country:US
Mailing Address - Phone:808-322-4818
Mailing Address - Fax:808-322-4817
Practice Address - Street 1:79-1020 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7922
Practice Address - Country:US
Practice Address - Phone:808-322-4818
Practice Address - Fax:808-322-4817
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW - 32291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI256640OtherALOHA CARE
HI0000256640Medicaid
HI0000241265OtherHMSA
HI55293Medicare ID - Type Unspecified