Provider Demographics
NPI:1801000344
Name:WIGERT, LEE R (MA, DMIN, PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:R
Last Name:WIGERT
Suffix:
Gender:
Credentials:MA, DMIN, PHD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:R
Other - Last Name:WIGERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIMHP, CPC
Mailing Address - Street 1:5802 N 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3283
Mailing Address - Country:US
Mailing Address - Phone:402-984-7186
Mailing Address - Fax:
Practice Address - Street 1:5802 N 169TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-3283
Practice Address - Country:US
Practice Address - Phone:402-984-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE416101YP2500X
NE354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84075OtherBCBS PREFERRED PROVIDER