Healthcare Provider Details

I. General information

NPI: 1063225902
Provider Name (Legal Business Name): THE WIG COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W MAYFLOWER WAY STE 124
LEHI UT
84048-3256
US

IV. Provider business mailing address

80 S 1300 E
PLEASANT GROVE UT
84062-3024
US

V. Phone/Fax

Practice location:
  • Phone: 801-899-9765
  • Fax:
Mailing address:
  • Phone: 707-761-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN SCHOW
Title or Position: OWNER
Credential: CPS
Phone: 801-899-9765