Basic Information
| Provider Information | |||||||||
| NPI: | 1902053150 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIGGERS | ||||||||
| FirstName: | BRIDGETTE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8819 COMMONS BLVD # 101 | ||||||||
| Address2: | |||||||||
| City: | TWINSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440872177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252212 | ||||||||
| FaxNumber: | 3304252779 | ||||||||
| Practice Location | |||||||||
| Address1: | 8819 COMMONS BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | TWINSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440872177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252212 | ||||||||
| FaxNumber: | 3304252779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 09/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 6447 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.