Doctor Name: | ELLEN AGNES WIGGINS |
NPI Number: | 1144337700 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | |
Business Practice Address: | 18154 Martin Ave Suite 3 Homewood, IL - 604302139 |
Business Phone Number: | 7082062755 |
Business Fax Number: | 7734291841 |
Mailing Address: | 18154 Martin Ave, Suite 3 HOMEWOOD |
State: | IL |
Postal Code: | 604302139 |
Phone Number: | 7082062755 |
Fax Number: | 7734291841 |
NPI Enumeration Date: | 08/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |