Healthcare Provider Details

I. General information

NPI: 1669267951
Provider Name (Legal Business Name): PLESIA GERTRUDE WIGGINS CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34290 FORD RD
WESTLAND MI
48185-3051
US

IV. Provider business mailing address

13227 MARK TWAIN ST # 2
DETROIT MI
48227-2809
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax:
Mailing address:
  • Phone: 313-506-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2333040200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: