MEDICARE: MS. DONNA MICHELE WIGAND L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	9297	CA

General Provider Information

NPI Number	:	1427104843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA MICHELE WIGAND L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 2676
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-0267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 ARNOLD DR
Second Line	:	SUITE 200
City	:	MARTINEZ
State	:	CA
Zip	:	94553-4189
Country	:	US
Telephone Number	:	925-957-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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