MEDICARE: NATASHA WIGGINS LSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.161612	OH
2	104100000X	Social Worker	S.2410619	OH

General Provider Information

NPI Number	:	1639689151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA WIGGINS LSW

Provider Business Mailing Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:	937-384-0581

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:	937-384-0581

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	05/20/2024

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