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NPI Code Detail

MEDICARE: BRIANA ELISE WIGGANS

MEDICARE: BRIANA ELISE WIGGANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12355S0801XSpeech-Language AssistantSLPA11314AZ

General Provider Information

NPI Number : 1114404001
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANA ELISE WIGGANS
Provider Business Mailing Address
First Line : 1922 E EL PARQUE DR
Second Line :
City : TEMPE
State : AZ
Zip : 85282-2902
Country : US
Telephone Number : 520-437-8385
Fax Number :
Provider Business Practice Location Address
First Line : 4545 N 36TH ST STE 125A
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-3456
Country : US
Telephone Number : 602-224-0202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2018
Last Update Date : 07/23/2018

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Directions to “ BRIANA ELISE WIGGANS ” Practice Location

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