Healthcare Provider Details

I. General information

NPI: 1346756350
Provider Name (Legal Business Name): COURTNEY WIGNER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 6TH AVE APT 201
SAN DIEGO CA
92103-7427
US

IV. Provider business mailing address

4201 6TH AVE APT 201
SAN DIEGO CA
92103-7427
US

V. Phone/Fax

Practice location:
  • Phone: 619-630-7219
  • Fax:
Mailing address:
  • Phone: 619-630-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00177100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4460
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-78840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: