Provider Demographics
NPI:1952542243
Name:WIGDER, KATHLEEN SALAT (PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SALAT
Last Name:WIGDER
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1452
Mailing Address - Country:US
Mailing Address - Phone:617-332-2268
Mailing Address - Fax:
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:800-510-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN97819163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAR93325Medicare UPIN
MAPN0554Medicare PIN