MEDICARE: DR. NEURINE ELAINE WIGGIN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01608133	OTHER	IL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1346211570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEURINE ELAINE WIGGIN PSY.D.

Provider Business Mailing Address
First Line	:	673 BLUFF ST
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1656
Country	:	US
Telephone Number	:	847-835-2738
Fax Number	:	847-835-2738

Provider Business Practice Location Address
First Line	:	673 BLUFF ST
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1656
Country	:	US
Telephone Number	:	847-835-2738
Fax Number	:	847-835-2738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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