Healthcare Provider Details

I. General information

NPI: 1659935559
Provider Name (Legal Business Name): ABIGAIL WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EXECUTIVE PL STE 201
GENEVA IL
60134-3805
US

IV. Provider business mailing address

1405 S 7TH ST
ST CHARLES IL
60174-3808
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-9843
  • Fax:
Mailing address:
  • Phone: 815-223-2337
  • Fax: 815-327-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1659935559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: