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General NPI Number Information
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NPI Number | 1740342419
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Entity Type | Individual
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Provider Name | GRETCHEN S. WIGTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 79-1020 HAUKAPILA ST
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City | KEALAKEKUA
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State | HI
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Zip | 96750-7922
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Country | US
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Telephone | 808-322-4818
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Fax | 808-322-4817
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Provider Business Mailing Address
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Address Line | 74-5037 HANAHANAI LOOP
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City | KAILUA KONA
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State | HI
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Zip | 96740-1538
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Country | US
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Telephone | 808-322-4818
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Fax | 808-322-4817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW - 3229
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License Number State | HI
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